Certified Coding Analyst (Remote)

Qualifications:

I. Education:

a. High school graduate or equivalent

II. Experience:

a. Previous experience in the medical field is preferred but not required.

b. Basic knowledge of the use and operation of general office equipment (i.e. phone, FAX, PC, and copier).

c. Working with the public in a courteous and professional manner.

d. Certification from the American Academy of Professional Coders (AAPC) or the American Health Information Management Association (AHIMA)

e. Certification from the AAPC as a Certified Professional Medical Auditor (CPMA), preferred.

f. Minimum of two (2) years coding and billing experience in physician practice

g. Experience with Microsoft Word, Excel and Windows based applications

h. Working knowledge of federal, state and local regulations, guidelines, and standards, including a working knowledge of HIPAA rules and regulations preferred but not required

i. Evidence of job stability

III. Necessary Skills:

a. Ability to maintain a positive attitude and provide great customer service under stressful situations.

b. Ability to communicate in a clear, concise, and pleasant manner in both verbal and written form.

c. Ability to multi-task.

d. Ability to adapt quickly to change.

e. Ability to work both independently and with physicians, clinical department staff and co-workers.

f. Ability to use and manage time efficiently.

g. Ability to follow the direction of supervisory personnel.

h. Ability to speak in a classroom setting.

i. Ability to provide coding guidance (verbal and written) to physicians and Advance Practice Providers

General Summary of Duties

This position will perform a variety of clerical duties necessary to the daily operation of the Business Office. These duties will include but are not limited to the following:

Act as a resource to the Central Business Office (CBO) and clinical departments for coding and documentation matters. Assist in the communication and/or denial process for reimbursement and coding issues with third-party payers and governmental payers. Assist in maintaining the integrity of the procedure codes utilized in the Athena billing system. Assist in medical record documentation reviews conducted by the Clinic’s Compliance Officer.

Job Relationships:

I. Responsible to:

a. Business Office Manager

Typical Job Demands:

I. Physical:

a. Requires functional near vision, distance vision, peripheral vision, color and depth perception.

b. Requires functional hearing

c. Requires prolonged sitting.

d. Requires eye‑hand coordination and manual dexterity

e. Requires the ability to distinguish letters or symbols

f. Requires the ability to sort and file materials correctly by alphabetic and/or numeric systems

g. Requires the ability to read, understand, and follow written and verbal instructions.

h. Requires the use of office equipment such as computer terminals, telephone, copier, FAX and scanner.

II. Psychological:

a. Requires the ability to work independently and follow through with assigned tasks and projects.

b. Requires the ability to retain information and recall it quickly under stressful situations.

c. Requires the ability to maintain a professional composure while handling stressful situations.

III. Interpersonal:

a. Requires the ability to provide great customer service to patients, patients’ families, and co-workers.

b. Requires good communication skills and the ability to interact with people from diverse backgrounds.

c. Requires the ability to quickly establish a positive and professional relationship with physicians, patients, and co-workers.

d. Requires the ability to follow through on requests from and commitments made to physicians, patients, and co-workers.

General Performance Requirements:

1. Protect the confidentiality of patients and co-workers.

2. Contribute to the overall morale of the department by being a positive and dependable team player.

3. Assist during staffing shortages by performing additional duties or working overtime as necessary.

4. Follow common safety, quality control, and biohazard waste requirements to establish a safe work environment.

5. Maintain current knowledge of and abide by the policies and procedures of the Harbin Clinic.

6. Participate in continuing education to maintain current coding certifications and enhance skill level.

7. Participate in activities that lead toward the established goals of the Harbin Clinic.

8. Attend all training required by Harbin Clinic (Orientation, Customer Service, OSHA, and Compliance, etc.) as directed.

9. Maintain current knowledge of all computer equipment and software applications used at Harbin Clinic.

10. Attend departmental staff meetings and in-services.

Essential Job Functions:

1. Act as a coding and medical record documentation resource for physicians, clinical department staff and Business Office staff.

2. Research and communicate revisions to coding and billing guidelines (the American Medical Association’s CPT, ICD-9-CM / ICD-10-CM. HCPCS II, the Centers for Medicare and Medicaid (CMS), etc.)

3. Provide educational sessions for physicians, clinical and billing staff.

4. Assist in maintaining the integrity of the procedure codes utilized in the billing system.

5. Assist in the communication process of resolving reimbursement or denial issues with contracted payers.

6. Assist in updating the clinical department billing slips

7. Assist in the medical record documentation reviews conducted by the Clinic’s Compliance Officer.

8. Assist in the appeal process for denials received as they relate to coding (e.g., unbundling, CPT/diagnosis inconsistent, etc.

9. Respond to third-party payer and governmental coding audits, including but not limited to RAC and CERT audits.

10. Provide coding guidance on claims placed in the CODINGRVW worklist in Athena.