Scheduled Hours

40

Position Summary

Position reviews medical record documentation to determine appropriate billing codes and necessary documentation. Performs advanced coding and appeal activities; investigates payer issues; responsible for timely filing of appeals to insurance companies; handles charge corrections.

Job Description

Primary Duties & Responsibilities:

• Reviews the documentation in the record to identify all pertinent facts for appealing the claims denied by third-party payers. Creates appropriate letters to substantiate the validity of claims.
• Codes evaluation and management to appropriate CPT code and codes diagnosis to appropriate ICD-10 code.
• Researches payer policies and processes.
• Meets with physicians to review documentation, resolve coding, and secure signature of unsigned dates of service, tagging files for follow-up. Investigates and problem-solves reimbursement issues in collaboration with other coding staff and faculty. Works directly with compliance or physicians and other clinical staff as needed to provide documentation feedback and to develop appeals.
• May act as a lead person and assists coders with IBC staff with medical terminology and policy interpretation as required.
• Assists with efforts to increase physician awareness of documentation requirements.
• Works assigned Epic Work queues and CRM tasks and reviews remittance advice for rejections and accuracy of payment amounts as needed. Identifies invoices that have been rejected per department criteria.
• Perform accounts receivable (AR) functions in the Epic billing system, including updating insurance information and demographics.
• Prepares case reports and initiates follow-up for billing process.
• Performs other duties as assigned.

Working Conditions:
Job Location/Working Conditions

• Normal office environment. Primarily remote, but is required to come into the office on a monthly basis

Physical Effort

• Typically sitting at desk or table.

Equipment

• Office equipment.

The above statements are intended to describe the general nature and level of work performed by people assigned to this classification. They are not intended to be construed as an exhaustive list of all job duties performed by the personnel so classified. Management reserves the right to revise or amend duties at any time.

Required Qualifications

Education:

A diploma, certification or degree is not required.

Certifications:

The list below may include all acceptable certifications and issuers. More than one credential or certification may be required depending on the role.

Certified Coding Associate (CCA) - American Health Information Management Association (AHIMA), Certified Coding Specialist (CCS) - American Health Information Management Association (AHIMA), Certified Coding Specialist - Physican based (CCS-P) - American Health Information Management Association (AHIMA), Certified Professional Coder (CPC) - American Academy of Professional Coders (AAPC), Certified Professional Coder - Apprentice (CPC-A) - American Academy of Professional Coders (AAPC), Certified Professional Coder - Hospital (CPC-H) - American Academy of Professional Coders (AAPC), Certified Professional Coder - Hospital Apprentice (CPC-H-A) - American Academy of Professional Coders (AAPC), Registered Health Information Administrator (RHIA) - American Health Information Management Association (AHIMA), Registered Health Information Technician (RHIT) - American Health Information Management Association (AHIMA)

Work Experience:

No specific work experience is required for this position.

Skills:

Not Applicable

Driver's License:

A driver's license is not required for this position.

More About This Job

Required Qualifications:

• Must have one of the following coding credentials: AHIMA (CCA, CCS, or CCS-P); AAPC (CPC, CPC-A, CPC-H, CPC-H-A, or one of the AAPC specialty-specific coding credentials (the specialty-specific credential is only valid for that employee’s department).

Preferred Qualifications:

• Previous coding experience or experience equivalent to an associate’s degree in a related field.
• Knowledge of ICD-10 and CPT coding.

Preferred Qualifications

Education:

Associate degree - Medical Coding & Billing

Certifications:

No additional certification beyond what is stated in