Required Education and Experience:
High School diploma or equivalent and a minimum of 5 years coding/healthcare reimbursement experience. Certification by American Academy of Professional Coders (CPC) for a minimum of 5 years or equivalent organization and CRC (Certified Risk Coder) certification. Must have advanced knowledge in medical terminology and anatomy. Must have advanced knowledge of insurance reimbursement, principles and practice. Must have knowledge of computer and Microsoft Office.
Develop educational material and conduct classes for coding and reimbursement education. Provides information based on CPT, ICD-10, HCPCS and RAF scores. Along with federal and local healthcare regulation reimbursement policies and procedures.
Conduct Classroom and Individual training/education of coding, reimbursement & payer guidelines to all providers and staff.
Identifies specific aberrances and atypical billing. Identify potential risks to the organization and ensure compliance to policies.
Review all reimbursement tools for coding/policy additions, revisions and deletions. Items must be communicated in a timely manner to all pertinent providers and staff.
Assist with per specialty practice assessments. Identify any potential risk. Ensure compliance to policies and procedures. Review pertinent payer regulations and coding guidelines. Review all applicable templates and current reimbursement tools pertinent to the specialty. Analyze denied services and adherence to federal and local guidelines.
Must remain current with CMS/Federal guidelines (i.e., federal register, transmittals and LCD�s). Review all updates published on a daily basis and distribute information to providers and staff.
Demonstrates a contribution to the department�s operation and goals/targets for the year. Maintains monthly log of activity. Prioritizes workload maintains control over interruptions.
Demonstrates ability to use coding software programs, IDX system, LCD and local hospital resources to conduct research. Ability to use IDX reports for retrospective or concurrent reviews, as assigned. Pursues medical records needed from outside resources (i.e. SNF, other hospitals)
Adheres to guidelines set by the clinic�s Compliance Program and Audit policy and procedures