Professional Coder TMCOne

SUMMARY:

Responsible for referring to patient’s medical records and selecting proper CPT-4, ICD 9, ICD 10, HCPCS codes to classify services performed, diagnostic information collected and treatments provided.  Assists Quality with reports and other staff as may be needed for special reports and or assistance.

ESSENTIAL FUNCTIONS:

Assists physicians, providers and management in generating and managing records for all billable activities that take place within the organization.

Audits physician and provider documentation within the electronic medical record for accuracy in representing the services provided.

Obtains any necessary clarification of information from physicians and providers regarding documentation within the electronic medical record.

Conducts ongoing ICD-9, ICD-10 documentation review (RAF) for each patient scheduled for a clinical day and provides physicians and providers with complete analysis prior to the clinic date.

Ensures all medical documentation for services provided has been signed/dated by the appropriate individual(s).

Ensures audit of visit document is completed and any coding changes are made so that the record is ready for medical billing within appropriate timeframe.

Provides information regarding patient accounts in response to inquiries, safeguarding confidential information in verbal replies and correspondence.

Provides routine daily internal and external interface with physicians, providers, management, staff, other service areas, information systems, software/hardware vendors, and third party payers in order to resolve issues with medical documentation and coding and to ensure payment is received.

Assists with problem solving, inquiries, and customer interaction to ensure positive results.

Trains and assists in the implementation of new software programs/systems and related technologies.

Adheres to department-specific safety and confidentiality policies and standards.

Performs billing and other related duties as assigned.

MINIMUM QUALIFICATIONS

EDUCATION:  High School diploma or General Education Degree (GED) or an equivalent combination of relevant education and experience.

EXPERIENCE: One (1) year of related professional record coding experience preferred.  Will consider exceptional new graduate candidates with CPC certification.

LICENSURE OR CERTIFICATION:   American Academy of Professional Coders CPC required.

KNOWLEDGE, SKILLS AND ABILITIES:

• Knowledge of medical terminology and coding related to professional billing such as, CPT-4 codes, ICD-9, ICD-10 codesand HCPCS codes.

• Knowledge of medical insurance practices and policies and regulations.

• Knowledge of government and non government uniform coding and billing guidelines.

• Skill in evaluating bills/claims for payers or patients in order to collect payment in a timely manner.

• Possesses and maintains knowledge of current regulatory and third party payer requirements to support billing reimbursement.

• Skill in providing assistance or training to other staff members in a team environment.

• Skill in the use of computer applications and systems including: EMR, Excel, Word, Internet, email, and miscellaneous programs and networked computer systems.

• Ability to read and comprehend instructions, short correspondence, and memos.

• Ability to write correspondence; ability to effectively present information in one-on-one and small groups situations to customers, clients, and other employees of the organization.

• Ability to read and interpret documents such as safety rules, procedure manuals, and government regulations.

• Ability to effectively present information and respond to inquiries or complaints from payors, patients and/or their representatives, and the general public.

• Ability to calculate figures and compute rate, ratio, and percent and to draw and interpret bar graphs; ability to apply basic algebraic concepts.

• Ability to apply common sense understanding to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists.