Under the direction of the Manager, Coding Compliance, the OP Ancillary/Physician Coder will play a key role in reviewing and analyzing billing and coding for processing. This role will be responsible for reviewing and accurately coding office, hospital, and surgical procedures for reimbursement. The OP Ancillary/Physician Coder will also be committed to ensuring accurate and compliant medical coding for both inpatient and outpatient services, diagnostic tests, and other medical services rendered to each patient.
Duties & Responsibilities: In adherence with standard work, analyze and interpret medical information in the medical record and assign and sequence the correct ICD-10-CM, CPT, and/or HCPCS code to the diagnoses/procedures of office, inpatient and/or outpatient medical records according to established coding guidelines. Achievement of productivity and quality standards as established by management. In adherence with standard work, conduct audits and provide ongoing education to MCMF physicians to maximize compliance and reimbursement. In adherence with standard work, follow Coding Compliance department standards and branding when communicating with clinical partners and fellow business center teams. Work collaboratively to solve billing and coding issues with Physician Billing Services Insurance and Customer Service Representatives. Employ strong understanding of the encounter/billing process and working knowledge of Medicare, Commercial, and HMO insurance, including the impact on reimbursement. Utilize medical reference resources and contacts to thoroughly research coding issues and maintain working knowledge of payment/reimbursement systems to ensure maximum reimbursement and coding compliance. In adherence with standard work, identify opportunities for billing/coding improvements. Participate in developing, implementing, and reviewing programs for coding compliance monitoring, criteria for benchmark comparisons, organizational policies and procedures, and physician clinical documentation improvement programs. Optimization opportunities include, but are not limited to, work in the Follow-Up and Claim Edit work queues and analyzing denial trends. In adherence with standard work, work weekly Missing Charge Reports to identify missed billable charges in order to maximize reimbursement. In adherence with standard work, take responsibility for various projects as assigned by management, and perform any additional/miscellaneous duties (not inclusive of job description) as requested by the management team within the scope of knowledge/ability.
Qualifications & Experience:
Minimum 3-years’ experience working in a hospital or physician’s office as a medical coder and interacting with physicians;
Expert knowledge of ICD10, CPT and HCPCS
Strong knowledge of medical terminology, anatomy and physiology