- High School/GED
- CPC or CCS required
- Medical coding experience required
- Primary Purpose: To serve as a coding and reimbursement consultant to physicians, managers and administration. Works to increase revenue by educating physicians, managers and staff on CPT and ICD-9 coding process. Conducts periodic chart reviews to ensure coding, billing and documentation practices are in compliance with current federal, state and private payer regulations and reports findings to appropriate parties.
Routine Decision Making: Type of training to be performed from analyzing audit data; how to implement changes to conform with regulations and guidelines; analyze data and make decisions according to interpretations; determine if documentation supports medical necessity; determine which ICD-9, HCPC, and CPT codes to assign; decide if reimbursement is accurate and take appropriate actions if necessary.
Required Knowledge: Knowledge of current insurance, Medicare and Medicaid requirements; medical terminology, anatomy and physiology; billing, coding, and reimbursement process; working knowledge of ICD-9, CPT and HCPC coding.
Required Skills and Ability: Ability to work well with others; organizational, communicative and teaching skills; computer skills; basic statistical skills including ability to analyze and report coding and utilization patterns; ability to prioritize, problem solve and work independently.
Education and Certification/ Registration Required for the Position: Technical or vocational school education or two year college training required. Certified Procedural Coder (CPC) or Certified Coding Specialist (CCS) required.