Coding and Medical Information Specialists are responsible for correctly coding healthcare claims in order to obtain reimbursement from insurance companies and government healthcare programs, such as Medicare and MCO’s; Review encounters to verify accurate and complete documentation exists and that charges meet required legal and insurance rules.
- Quality Optimization to enhance care team performance to obtain better reimbursement.
- Review encounters daily to verify charges are submitted correctly.
- Verifying EPSDT coding and CPTII incentive codes are applied to encounters prior to submission.
- Utilize specialized medical classification software to assign procedure and diagnosis codes for insurance billing.
- Review claims data to ensure that assigned codes meet required legal and insurance rules.
- Investigate and correct denied claims by conducting medical records research and corresponds with insurance companies and healthcare professionals to resolve the issue.
- Answer questions related to tasks about specific claims.
- Generating reports weekly for encounters without charges.
- Correcting denied claims.
- Work closely with care teams to improve documentation of required data for variety of programs and payor incentives.
- Other duties as assigned by supervisor.
- Adheres to the organizations mission, vision and values.
- Adheres to the organization’s policies regarding time and attendance.
- Complies with accepted dress code and maintains a professional image.
- Demonstrates reliability and trustworthiness.
- Manages time and other resources to meet established goals within the agreed upon time frames.
- Demonstrates flexibility in the acceptance and completion of work assignments.
- Participates in the department’s performance improvement activities.
- Maintains patient/employee confidentiality in the management of information.
- High School Diploma required
- Certified Professional Coder (CPC) certificate or associate's degree in medical coding, health information technology or a related field required
- 1 or more years experience in a medical office
- Medical office billing experience
- Bookkeeping or finance knowledge
- Attendance required at assigned CHDC site(s)
- This position requires compliance with Health Center’s written standards, including its Standards of Conduct and policies and procedures (“Written Standards”). Such compliance will be an element considered as part of the employee’s regular performance evaluation.
- Failure to comply with Health Center’s Written Standards, which may include the failure to report any conduct or event that potentially violates legal or compliance requirements or Health Center’s Written Standards, will be met by the enforcement of disciplinary action, up to and including possible termination, in accordance with Health Center’s Compliance Program Policy and Procedure: Addressing Instances of Non-Compliance Through Appropriate Disciplinary Actions.
External and internal applicants, as well as position incumbents who become disabled, must be able to perform the essential job specific functions (listed within each job specific responsibility) either unaided or with the assistance of a reasonable accommodation to be determined by the organization on a case-by-case basis.