Description :

1. Reviewed and coded Neurology, ENT, Plastic Surgery, Family practice, Internal Medicine, and Vascular of Medicine.
2. Reviewed reports and performed internal E&M audits hospitalist groups.
3. Made sure Documentation standards for medical record E&M guidelines.
4. Reviewed reimbursement of payers and complete recoupment when there is reimbursement deficiency.
5. Provided coding reviews and recommendation for correction to the Manager of Reimbursement and Education.
6. Analyzed A/R and claim denials for trends directly related to reimbursement issues to assist with improving department results.
7. Addressed RAC and other recoupment efforts of government and PPO payers for accuracy.
8. Worked denied and appeal queues as well as makes recommendation in relation to Account Representative processes when appropriate.

Experience

0-2 Years

Level

Entry Level

Education

Diploma

Description :

1. Responsible for all coding including outpatient and inpatient surgical procedures, in-office surgeries, in-patient consults, emergency room visits and a large volume of E/M coding for 14 physicians.
2. Ensure a thorough understanding of each surgery performed by reading Operative Notes, Pathology Reports and if necessary consulting with the physician that performed the procedure.
3. Responsible for invoices associated with each surgery and applying them to each patient.
4. Schedule inpatient and outpatient surgeries.
5. Conduct in house audits for 14 physicians in our practice.
6. Answer numerous questions via email and telephone throughout each day regarding procedures from physicians and more than 40 ENT Associates employees.
7. Advise coders via Internet in other Birmingham area hospitals on coding procedures.

Experience

7-10 Years

Level

Management

Education

Diploma

Description :

1. Responsible for performing coding/auditing of medical records retrospectively to ensure ICD-9 codes that are submitted to the Centers of Medicare and Medicaid Service (CMS) for Risk Adjustment Payment System (RAPS) are accurate and are supported by written clinical documentation/criteria in accordance with ICD-9 official guidelines, state and federal regulations, and UPMC Health Plan internal policies and procedures.
2. Ability to code using ICD-9-CM and appropriately assigning diagnosis codes after reviewing all clinical documentation available.
3. Performs audits to determine accuracy of code selection and assists with risk adjustment validation (RADV) audits.
4. Responsible for validating diagnoses submitted via claims to the Health Plan by reviewing inpatient, outpatient and provider office documentation, reviewing clinical criteria.
5. Assists with inter-rater reliability audits and conducts review of coded materials to ensure compliance with coding guidelines and principles and CMS Risk Adjustment Participant Guidelines.
6. Identifies topics for training and education and assists with training of new hires.
7. Helps support daily operational functions of the Medicare HCC Risk Adjustment Department.
8. Provides technical support to medical abstractors, as needed, for software and hardware issues they may encounter out in the field when performing chart reviews.

Experience

0-2 Years

Level

Entry Level

Education

BUSINESS ADMINISTRATION

Description :

1. Preview all insurance claims to ensure accuracy, compliance and conformity with AMA, CMS, AAPC and payer specific guidelines for more than 250 providers (Women's Health CT and Women's Health NY).
2. Review patient medical records to ensure that coding change(s) are supported by medical record documentation.
3. Appeal denied or inappropriately bundled claims when necessary.
4. Respond daily to all internal and external divisional staff questions associated with coding.
5. Train divisional and internal staff in OB-GYN specific coding.
6. Attend and participate in payer meetings on a monthly or as needed basis.
7. Update, maintain and communicate payer specific guideline information, AMA and CMS updates to internal and external staff.
8. Perform chart audits as needed to ensure that patient medical record documentation supports the code(s) billed to patients and health plans.

Experience

2-5 Years

Level

Junior

Education

Diploma

Description :

1. Reviewed and verified proper coding of, ICD- 9, and CPT code sets.
2. Maintained up to date CPT, ICD - 9, and HCPCS code sets.
3. Reviewed, monitored, audited, and reconciled patient accounts for accurate billing.
4. Responsible for uncollectable accounts; reviewed the accounts in regards to dates of service, authorization, and codes.
5. Processed insurance and patient claims timely and accurately.
6. Performed monthly reviews and quality audits for compliance for the federal government.
7. Followed up with insurance carriers to resolve open insurance claims / denials and balances proficiency with CPT, ICD-9, and HCPCS coding.
8. Verified of Client's Insurance (benefits, Deductible and Co-Insurance) and assigned Private Pay Agreements for Private Pay Policies.

Experience

2-5 Years

Level

Junior

Education

Associate's

Description :

1. Provide coding and auditing services for a variety of medical specialties.
2. This includes the analysis and translation of medical and clinical diagnoses, procedures, injuries, or illnesses into designated ICD-9 and CPT codes.
3. Perform documentation assessment and review for accurate abstracting of clinical data to meet regulatory and compliance requirements, ensuring coded data accurately reflects services provided, guarding against fraud and abuse.
4. Provide ongoing feedback and education to coding staff and providers.
5. Accomplishments: Coder for six provider specialties, to include Internal Medicine, Infectious Disease, Orthopedic Surgery and OBGYN.
6. Inpatient, Outpatient, clinical and office coding knowledge/experience.
7. Analyze provider documentation to assure and/or assign the appropriate Evaluation and Management (E&M) levels.

Experience

2-5 Years

Level

Junior

Education

CPT In Insurance Verification

Description :

1. Reviews and codes designated office/hospital notes for one or multiple practices.
2. Abstracts CPT-4, HCPC II, and ICD-9 CM from medical records.
3. Receives and reviews charge documentations from clinic and/or hospital.
4. Charge entry into billing system in timely manner.
5. Resolves complex coding scenarios and resolve coding related denials.
6. Provides feedback and documentation advice to the physician; non-physician practitioner, and practice management.
7. Assists and direct the practice or other appropriate staff regarding documentation, billing, coding, and reimbursement issues.
8. Works in conjunction with A/R team on follow up and resolution of coding related denials rejections.

Experience

5-7 Years

Level

Executive

Education

Bachelor's

Description :

1. Precisely completed appropriate claims paperwork, documentation and system entry.
2. Correctly coded and billed medical claims for various specialties.
3. Thoroughly researched newly identified diagnoses and/or medical procedures to expand skills and knowledge.
4. Meticulously identified and rectified inconsistencies, deficiencies and discrepancies in medical documentation.
5. Maintained updated knowledge of coding requirements, through continuing education and certification renewal.
6. Entered orders into the EMR system efficiently and without errors.
7. Assigned appropriate medical codes with a number percent accuracy rate.

Experience

10+ Years

Level

Senior

Education

Certificate Of Achievement

Description :

1. Responsibilities: Assists physicians, patients, insurance representatives, procedure schedulers and managers by identifying problem billing patterns and correcting insurance denials.
2. Audit/Research problems pertaining to coding by reviewing submitted claims, denials and reimbursements to ensure maximum reimbursements from payors.
3. Maintain regulatory/compliance environment by following organizational policies and procedures to ensure compliance to state, local and federal standards and regulations.
4. Receive insurance denials and requests and reviews patients' medical records to resubmit claims using Accurate codes and following professional coding standards to ensure maximum reimbursement from payors.
5. Review and assist with hospital charge processing using current and accurate coding practices.
6. Initiates correspondence to and answer rejections from insurance companies regarding patients accounts and claim appeals by following established insurance protocols.
7. Works with Cardiology Associates staff through the Practice Management system's tasking function to obtain the necessary documentation prior to following up and submitting claims that require referrals, records or additional information.
8. Communicates and initiates correspondence with insurance companies to resolve coding discrepancies to ensure maximum reimbursement from payors.

Experience

5-7 Years

Level

Executive

Education

Bachelor Of Arts

Description :

1. Responsible for maintaining an assigned portfolio of clients.
2. Determine the benefits and services the relocating employee will receive based on the client matrix provided and distribute to the appropriate departments within Cartus.
3. Work closely with client services and account management to ensure the coding matrices are kept up to date.
4. Assist manager with data integrity projects and clean up projects for business units.
5. Facilitate team training, cross training development for IC Coordinators.
6. Client Services Consultant Served as the major point of contact to the transferring employee, navigating the customer through his/her relocation.
7. Maintained an assigned caseload while delivering impeccable customer service to external and internal customers.
8. Communicated via phone the client's relocation program/policy to transferring customers.

Experience

7-10 Years

Level

Management

Education

Bachelor Of Arts In Communications

Description :

1. Coded patient claims using ICD-9 and CPT codes, supporting office with five full- time physicians, one part-time physician, and 19 nurse anesthetists.
2. Worked with Medicare, Medicaid, and private insurance claims.
3. Developed skill in identifying errors that resulted in nonpayment and meticulously documenting justifications for payment.
4. Used hospital's Meditech system; utilized Internet resources to double-check accurate procedure names and codes.
5. Ran monthly business reports along with office administrator; these included aging reports, broken down by CPT code and volume of each unit.
6. Followed up on aging reports; significantly reduced number of unpaid and underpaid claims and maintained excellent record of winning disputes with insurance companies by providing documentation to prove validity of claims.
7. Provided documentation and codes for Medicare Physician Quality Reporting Initiative, tracking adherence to protocols.
8. Ensured patient claims were coded within one week of date of procedure, reducing previous backlog of three- to four-week delay.

Experience

10+ Years

Level

Senior

Education

A.A.S.

Description :

1. Review medical record documentation to accurately assign medical codes to all diagnoses and/or services, for purposes of classification of morbidity and mortality data for statistics using ICD-9-CM, CPT, and HCPCS coding systems.
2. Review medical documentation for accuracy and compliance with inpatient and outpatient coding and coverage rules.
3. Determine Diagnosis-Related Groups (DRGs) and Hierarchical Condition Categories (HCCs) based on codes assigned.
4. Evaluate and confirm final determinations on discrepant records.
5. Mediate coding decisions between coders utilizing appropriate resources to support decisions.
6. Recommend resolutions in keeping with the Centers for Medicare & Medicaid Services (CMS) and company policy.
7. Facilitate, contribute to, and attend various administrative meetings.
8. Maintain internal control processes for all activities in compliance with the Health Insurance Portability and Accountability Act (HIPAA).

Experience

0-2 Years

Level

Entry Level

Education

M.A.

Description :

1. Managed and processed in/outpatient billing and procedural codes for Emergency Department and Outpatient Surgery.
2. Communicated with physicians and clinical documentation specialists to ensure dictation accuracy, as well as with providers to appeal claim denials.
3. Established and maintained positive relationships with physicians, clinical documentation specialists and floor personnel.
4. Coordinated medical necessity of outpatient testing.
5. Maintained top accuracy and productivity records for ICD-9, CPT and HCPCS coding exceeding 98%.
6. Achieved daily production maintaining top production performance, while exceeding quality goals.
7. Assisted in internal audits of in/outpatient procedural records; analyzed medical records to identify inaccuracies.

Experience

10+ Years

Level

Senior

Education

Psychology

Description :

1. Managed outpatient accounts on a daily basis utilizing data from HIMD specific edit report as well as the Hospital-wide.
2. Analyzed the health information management component of the revenue cycle, and communicated with coworkers.
3. Met departmental productivity standards of accounts.
4. Worked closely with Patient Access Director, HIMD Director, and Lab Director to clarify and streamline procedures for compliant physician orders and image archiving for coder access.
5. Identified abstractable information from a compliant physician order.
6. Entered required data elements into Meditech for billing and statistical purposes.
7. Decreased unbilled outpatient ancillary account amounts from 6 million dollars to 74 thousand by month-end, to meet facility goals.

Experience

7-10 Years

Level

Management

Education

AAS

Description :

1. Maintained a 50 chart productivity rate.
2. Reviewed health risk assessments/evaluations to determine completion and compliance with CMS guidelines.
3. Reviewed and assessed the accuracy, completeness, specificity, and appropriateness of diagnosis codes.
4. Identified in the health risk assessments/evaluations.
5. Maintained adequate knowledge of coding, compliance, and reimbursement procedures related to Medicare Risk Adjustment.
6. Made recommendations for coding policy.
7. Followed all legal and policy requirements for HIPAA protected data.

Experience

2-5 Years

Level

Junior

Education

AAS In Health

Description :

1. Used CPT, ICD 9, ICD 10, hcpcs, audit Dr charts to ensure correct coding before sending out to insurance.
2. Reached out to physicians if additional information is needed.
3. Passed the ICD-10 requirement test.
4. Knowledge of EMR, Microsoft Office, Epic, close relationship with the manager, and education manager. 
5. Performed assignment of ICD 10 CM and CPT procedure codes of emergency room encounters.
6. Reviewed and analyzed emergency room encounters for completeness and supportive medical record documentation.
7. Queired providers when necessary for clarification.

Experience

7-10 Years

Level

Management

Education

AAS In Health