Responsible for abstraction and accurate coding of procedures from various forms and medical records to ensure optimal reimbursement and compliance with all regulations, policies and procedures.

• Abstracts and codes by Current Procedural Terminology (CPT) and International Classification of Diseases (ICD) procedures and diagnosis from medical records. 
• Verifies medical record documentation requirements. Responsible for verifying that CPT, Healthcare Common Procedural Coding System (HCPCS) & ICD coding used is correct. 
• Responsible for verifying that payment is correct for CPT, HCPCS & ICD coding.
• Reviews charging procedures to ensure compliance with Federal regulations, and Medicare and Medicaid Policies.  Verifies correct interpretation was used in the calculation of write-offs.
• Advises and educates faculty in regard to charge documentation, diagnosis, procedure coding, and charge policies. Coordinates and trains staff on reimbursement procedures. 
• Monitors monthly financial flow charts to detect problems. Performs charge corrections. 
• Reviews patient admitting records and extracts relevant information. Records patient and demographic information in the billing system. Contacts agency representative to verify type and extent of coverage.
• Reviews source documents to determine if there is sufficient data to process. Batch charges, generate hash totals, enters charges, and balances batches to source documents and hash totals.
• Compiles patient documentation, demographics, billing, insurance, and status of approvals or denials from insurance carriers, hospital information system, insurance companies, or other entities. 
• Completes processing of all inpatient and outpatient documents. Assists with resolving department problems with patient billing. Maintains records of charges, payments, and third party charges.
• May receive incoming calls from patients or third party carriers regarding delay in statements or claims. Resolves issues. Records results of calls in the billing system. 
• Contacts insurance carriers regarding non-payment or improper payment of claims. Reviews denials.
• Assists with reviews and balances patient billing transactions.  Reconciles daily patient billing receivables. Prepares billing statements from statistical data.
• Prepares daily refund check requests and credit balances other than refunds. Post refund checks to patient accounts. Mail refund checks with supporting documents.
• Performs various duties as needed to successfully fulfill the function of the position. 

Education:

Required: High School Diploma or GED.

Experience:

Required: 6 months experience with medical insurance, billing or clinical coding.

Certifications or Licenses:

Will accept any of the following certifications in lieu of the 6 months experience:

·        Certified Professional Coder Certification (CPC) or
·        Registered Health Information Technician Certification (RHIT) or
·        Certified Outpatient Coder (COC) or
·        National Healthcare Association Certification (NHA) or
·        Certified Coding Specialist (CCS) or
·        Certified Coding Specialist Physician based (CCS-P)  

• Knowledge of CPT and ICD coding processes and determine which documentation is required to enter into the coding system
• Knowledge of the different insurance carriers and their processes
• Knowledge of medical billing
• Knowledge of Health Insurance Portability and Accountability Act (HIPAA)
• Excellent customer service
• Ability to handle stressful situations in a professional manner
• Ability to recognize a problem and solve in a timely manner

Physical:

Sit for prolonged periods. Communicate effectively and listens. Use of computer, calculator, and telephone.  

Environmental: 

Standard office environment. Exposure to difficult customers and third party carriers over billing and coding issues.