Under the supervision of the Revenue Cycle Manager, this position is responsible for the auditing, monitoring, and education of the Certified Coders in the Central Billing Office and UHMG and UHMP providers.
Essential Functions of the Position
1. Monitors all Billing/Coding Trends for problems in reimbursement, coding, or charge entry. Works with internal departments and medical offices to offer solutions.
2. Audits the work of certified coders to determine appropriate claim resolution and compliance with all internal and external billing and coding guidelines.
3. Monitors trends to identify areas of risk and takes appropriate action to educate staff, physicians and management.
4. Organizes monthly educational sessions for CBO Coding staff. Targets trends, risks, or issues that have been identified.
5. Attends educational sessions to remain current with updated coding and billing guidelines. Uses information to educate staff.
6. Researches and responds to questions from the readers of the Coding Connection Website.
7. Responsible for learning ICD-10-CM and training staff as changes occur.
8. Assists the RC Management in the development of new procedures that focus on improvement in quality within the Revenue Cycle department.
9. Provides data compilation and analysis of coding, billing and reimbursement issues to the physicians, the RC Manager and other internal auditors.
10. Acts as a liaison between the Central Billing Office, providers and staff. Effectively communicates issues relative to claims processing difficulties and/or patient complaints.
11. Responsible for identification of coding deficiencies and the participation of educational programs for new and established physicians and staff on coding, documentation and reimbursement.
* E/M Coding
* Specialty coding (surgical and procedural)
* Compliance Risks
* Maximizing Reimbursement
* Communication of government and private payer updates
* Coding Corner Newsletter
12. Responsible for the periodic review of billing policy compliance.
13. Responsible for researching coding questions and making final decisions based on extensive research of publications and manuals.
14. Ensures compliance with all federal, state, and local regulations governing coding, documentation and reimbursement guidelines.
15. Maintains working knowledge of all managed care contractual relationships and ensures that documentation and coding requirements contained within are followed.
16. Makes recommendations in regard to annual charge ticket maintenance to accurately use CPT & ICD-10 codes.
17. Maintains strict confidentiality in regard to patient's personal, medical and financial information.
18. Acts as a role model for professionalism through appropriate conduct and demeanor at all times.
19. Performs additional duties as assigned.
1. Educational Requirements
High School diploma or equivalent required.
2. Experience Requirements
At least 7 years coding experience required. Working knowledge of medical terminology, anatomy and physiology required. Previous experience in provider/ physician education required.
3. Required Licenses and/or Certificates
Certified Coding Certificate Required
* CCS-P or CPC
4. Skills and Abilities
Excellent interpersonal skills to work in partnership with others to influence and gain cooperation. Ability to recognize, evaluates, and solves problems. Strong verbal and written communication skills. High tolerance level for dealing in a potentially stressful environment. High knowledge of the claims development process, as well as third party insurance program requirements. Knowledge of ICD-10and CPT coding as well as reimbursement. Computer literate, experience with basic software packages.
Equal Opportunity Employer - minorities/females/veterans/individuals with disabilities/sexual orientation/gender identity.
Location/Region: Cleveland, OH (US - 44118)