POSITION SUMMARY

To provide superior quality, competitive value and outstanding service through supporting the healthcare providers and clinical staff and billing and collections functions of the Business Office. Communicates effectively with providers and clinical staff with issues related to billing functions and reimbursement.

GENERAL EDUCATION REQUIREMENTS

Medical Coding Certificate – CPC certification is required.

Two years’ experience using ICD-10, CPT, and HCPCS.

ADDITIONAL QUALIFICATIONS

• Federal laws and regulations affecting coding requirements.
• Principles, practice and methods of current coding certification required.
• Proficient in all coding systems to include ICD-10, CPT and HCPCS.
• Knowledge of billing practices required, FQHC billing preferred.
• Knowledge of medical records, EHR required.
• Extensive knowledge of official coding conventions and rules established by the American Medical Association (AMA), and the Center for Medicare and Medicaid Services (CMS) for assignment of diagnostic and procedural codes.
• Must have effective communication skills.
• Attention to accuracy and specific detail for competent performance.

PRIMARY ACCOUNTABILITIES

• Audits medical records to ensure proper coding completed and to ensure compliance with federal and state regulatory bodies.
• Audits billing records to ensure proper submission of services.
• Supplies correct ICD-10 diagnosis codes on all diagnoses provided.
• Supplies correct HCPCS code on all procedures and services performed.
• Supplies correct CPT code on all procedures and services performed.
• Provides education to providers, clinical staff and billing staff on correct coding information.
• Qualitative analysis – Performs a comprehensive review to assure the presence of all component parts such as: patient and record identification and all other necessary data in the presence of all reports which appear to be indicated by the nature of the treatment rendered.
• Quantitative analysis – Evaluates the record for documentation consistency and adequacy. Ensures that the final diagnosis accurately reflects the care and treatment rendered. Reviews the records for compliance with established reimbursement and special screening criteria.
• Analyzes provider documentation to assure the appropriate Evaluation & Management (E&M) levels are assigned using the correct CPT code.
• Performs other related duties, which may be inclusive, but not listed in the job description.

PHYSICAL DEMANDS

• Visual acuity, hand-eye coordination, hearing ability and dexterity to perform tasks and operate office equipment.
• Standing, walking, bending, stooping, and lifting as job requires for possibly extensive periods of time.
• Manual dexterity sufficient to operate a keyboard, photocopier, telephone, calculator and other office equipment.
• Normal range of hearing and eyesight to record, prepare and communicate appropriate reports.

MENTAL DEMANDS

• Work in a stressful, public contact environment.
• Professionalism, courtesy and respect required when interacting with patients and staff.
• Concentration on multiple priority activities in a fast paced, stressful environment.
• Exercising of appropriate judgment when responding to emergency or complex situations.
• Maintenance of confidentiality in accordance with Health Insurance Portability and Accountability Act (HIPAA).
• Assess and interpret data to educate staff.