To review and edit charge sessions and tickets, ensuring proper use of diagnosis and procedure codes for accurate billing and maximum reimbursement. Completes charge sessions and tickets by applying modifiers, CCI edits, etc., and batches according to department policy.
- Reviews electronic coding work queues for charges presented for proper use of diagnosis and procedure codes.
- Receives paper charge tickets and appropriately prepares for charge entry.
- Confirms accurate patient demographics on each ticket including MSN #, patient #, insurance information, etc. according to department policy.
- Verifies service provider and billing provider number fields are populated.
- Verifies referring provider number field is populated, if appropriate.
- Applies knowledge of coding rules, verifies the proper use of the following items, and makes appropriate corrections:
- Payor specific billing guidelines
- ICD10 diagnosis codes
- CPT4 E&M and procedure codes
- HCPCS codes
- CCI edits
- Multiple surgery guidelines
- DMERC guidelines
- Rural Health guidelines
- Effectively uses software and/or coding books to verify coding accuracy.
- Reviews charge sessions for proper coding for special departments (e.g., Charity care, special accounts, MVA, L&I, etc.) and transfers session to the appropriate specialist for completion.
- Responsible to stay current with billing guidelines and reimbursement rules and regulations.
- Provides feedback to providers regarding incorrect coding using authorized methods as dictated by department policy.
- Works with clinical staff to resolve coding issues and related problems.
- Participates in educational activities as requested (i.e., attending meetings with clinical staff).
- Completes production logs as required for department statistical reporting.
- May be requested to perform job tasks not specifically related to primary assignments for the success of the organization as requested by management.
Demonstrate Standards of Behavior and adhere to the Code of Conduct in all aspects of job performance at all times.
- High School graduate or equivalent.
- Proficient in the performance of basic math functions.
- Possesses basic computer (e.g., spreadsheets, word processing) skills.
- Must be a team player.
- Maintains a positive, resourceful attitude toward achieving overall department and clinic goals.
- Must pass all department requirements for training and audits within six months of employment.
· Knowledge of ICD-10, CPT coding, medical terminology, and insurance billing.