Address
Form of workEssential Job Responsibilities
Coding and Charge Capture
Assigns accurate medical codes for diagnoses based on the most updated set of ICD-10 guidelines
Assigns accurate procedures and evaluation and management services according to the appropriate classification system for outpatient encounters, and based on the 95/97 guidelines provided.
Reviews all clinical progress notes for accuracy and completeness. Obtain missing information from Providers and clinical staff members, and report them to the supervisor immediately and prior to processing the claim.
Identifies all chargeable items within each progress note and ensure proper CPT/HCPCS codes for each item.
Enters all necessary modifiers accurately.
Posts pending Medical and Behavioral Health charges in the EHR.
Reviews the unresolved encounters report once every two weeks to capture services for which charges were not appended by the different departments
Provides technical guidance to providers in identifying and resolving issues or errors, such as incomplete or missing records and documentation, or codes that do not conform to approved coding principles/guidelines.
Educates and advises providers and ancillary staff on proper code selection, procedures and requirements.
Reviews all entries in the EHR by the different departments, and captures the coding and billing for all services rendered to the patients per visit to maximize revenue and prevent losses to the Health Care Center
Assists in identifying training needs, and preparing training materials.
Supports the billing team in verifying and correcting coding issues per insurance requests or claim denials.
Follows up on outstanding claims per payer assigned by management, and ensures payment is received within a timely manner Assists in claims appeals by reviewing the clinical/medical documentation, and in collecting further documentation from providers as needed to support the necessity of services rendered
Participates in coding reviews as needed.
Works payer projects as directed.
Attends meetings related to billing for Medical and Behavioral Health services as required.
Maintains performance expectations of accurately processing claims per day targets defined by management.
Maintains a strong knowledge of Medicare and other third-party regulations and requirements
Culture of Service: 3 C's
Compassion
• Greets internal or external customers (i.e. patient, client, staff, vendor) with courtesy, making eye contact, responding with a proper tone and nonverbal language.
• Listens to the internal or external customer (i.e. patient, client, staff, vendor) attentively, reassuring and understanding of the request and providing appropriate options or resolutions.
Competency
• Provides services required by following established protocols and when needed, procure additional help to answer questions to ensure appropriate services are delivered
Commitment
• Takes initiative and anticipates internal or external customer needs by engaging them in the process and following up as needed
• Prioritize internal or external customer (i.e. patient, client, staff, vendor) requests to ensure the prompt and effective response is provided
Safety
Ensures proper handwashing according to the Centers for Disease Control and Prevention guidelines.
Understands and appropriately acts upon the assigned role in Emergency Code System.
Understands and performs assigned roles in the organization's Continuity of Operations Plan (COOP).
Contact Responsibility
The responsibility for internal and external contacts is frequent and important.
Licenses or certification
AAPC certification required.
Physical Requirements
This work requires the following physical activities: frequent sitting, bending, standing, walking, talking in person and talking on the phone. Occasional driving, stretching/reaching and lifting up to 50 lbs. are required. Work is performed in an office setting.
Other
Participates in health center developmental activities as requested.
Other duties as assigned.
Own transportation is required.
JOB SPECIFICATIONS
Education:
High school degree required. Certified Professional Coder (CPC) certification required.
Training and Experience:
A minimum of two years of experience in medical coding experience within an outpatient facility. Knowledge of Medicare reimbursement methodologies and other third-party regulations is required. Trainings in HIV/AIDS preferred.
Job Knowledge and Skills:
Bilingual (English-Spanish/ English-Creole) is preferred. Knowledge of Intergy EMR and/or NextGen EHR is a plus. Excellent knowledge of anatomy and physiology, medical terminology, pharmacology and disease processes are required. Excellent written & oral communication skills, organizational and analytical skills, and customer service skills are required. Ability to work with multicultural and diverse population is required.
Coding and Charge Capture
Assigns accurate medical codes for diagnoses based on the most updated set of ICD-10 guidelines
Assigns accurate procedures and evaluation and management services according to the appropriate classification system for outpatient encounters, and based on the 95/97 guidelines provided.
Reviews all clinical progress notes for accuracy and completeness. Obtain missing information from Providers and clinical staff members, and report them to the supervisor immediately and prior to processing the claim.
Identifies all chargeable items within each progress note and ensure proper CPT/HCPCS codes for each item.
Enters all necessary modifiers accurately.
Posts pending Medical and Behavioral Health charges in the EHR.
Reviews the unresolved encounters report once every two weeks to capture services for which charges were not appended by the different departments
Provides technical guidance to providers in identifying and resolving issues or errors, such as incomplete or missing records and documentation, or codes that do not conform to approved coding principles/guidelines.
Educates and advises providers and ancillary staff on proper code selection, procedures and requirements.
Reviews all entries in the EHR by the different departments, and captures the coding and billing for all services rendered to the patients per visit to maximize revenue and prevent losses to the Health Care Center
Assists in identifying training needs, and preparing training materials.
Supports the billing team in verifying and correcting coding issues per insurance requests or claim denials.
Follows up on outstanding claims per payer assigned by management, and ensures payment is received within a timely manner Assists in claims appeals by reviewing the clinical/medical documentation, and in collecting further documentation from providers as needed to support the necessity of services rendered
Participates in coding reviews as needed.
Works payer projects as directed.
Attends meetings related to billing for Medical and Behavioral Health services as required.
Maintains performance expectations of accurately processing claims per day targets defined by management.
Maintains a strong knowledge of Medicare and other third-party regulations and requirements
Culture of Service: 3 C's
Compassion
• Greets internal or external customers (i.e. patient, client, staff, vendor) with courtesy, making eye contact, responding with a proper tone and nonverbal language.
• Listens to the internal or external customer (i.e. patient, client, staff, vendor) attentively, reassuring and understanding of the request and providing appropriate options or resolutions.
Competency
• Provides services required by following established protocols and when needed, procure additional help to answer questions to ensure appropriate services are delivered
Commitment
• Takes initiative and anticipates internal or external customer needs by engaging them in the process and following up as needed
• Prioritize internal or external customer (i.e. patient, client, staff, vendor) requests to ensure the prompt and effective response is provided
Safety
Ensures proper handwashing according to the Centers for Disease Control and Prevention guidelines.
Understands and appropriately acts upon the assigned role in Emergency Code System.
Understands and performs assigned roles in the organization's Continuity of Operations Plan (COOP).
Contact Responsibility
The responsibility for internal and external contacts is frequent and important.
Licenses or certification
AAPC certification required.
Physical Requirements
This work requires the following physical activities: frequent sitting, bending, standing, walking, talking in person and talking on the phone. Occasional driving, stretching/reaching and lifting up to 50 lbs. are required. Work is performed in an office setting.
Other
Participates in health center developmental activities as requested.
Other duties as assigned.
Own transportation is required.
JOB SPECIFICATIONS
Education:
High school degree required. Certified Professional Coder (CPC) certification required.
Training and Experience:
A minimum of two years of experience in medical coding experience within an outpatient facility. Knowledge of Medicare reimbursement methodologies and other third-party regulations is required. Trainings in HIV/AIDS preferred.
Job Knowledge and Skills:
Bilingual (English-Spanish/ English-Creole) is preferred. Knowledge of Intergy EMR and/or NextGen EHR is a plus. Excellent knowledge of anatomy and physiology, medical terminology, pharmacology and disease processes are required. Excellent written & oral communication skills, organizational and analytical skills, and customer service skills are required. Ability to work with multicultural and diverse population is required.
