The Billing Representative-Certified Coder must have a thorough knowledge of the coding guidelines for all ICD-10 diagnosis codes, CPT and HCPC procedures codes, modifiers and their use with hospice care. This position will review accounts to ensure accurate coding for claims. This position will review documentation to adhere to coding guidelines, identify opportunities, and work with medical staff to educate and assist with coding knowledge. The Billing Representative-Certified Coder will assist with generating, processing and following up on assigned claims and maintain relationship with payers to ensure timely reimbursement and resolution of claims.
Position Duties & Responsibilities:
Develop and present coding education to Medical Staff.
Audit and review physician/APRN documentation.
Ensure documentation supports E&M visit code by physician/APRN.
Identify opportunities to enhance documentation skills for medical staff.
Monitor levels of care for accuracy and work with teams to resolve discrepancies.
Generates and processes all activity related to billing on a monthly basis.
Processes 81As and other information/transactions.
Processes secondary billing as needed.
Processes physician billing as needed.
Ensure accurate transmission of monthly billing and electronic file.
Utilizes on-line look-up and processing capabilities to monitor claims and resolve issues to expedite reimbursement.
Works with Benefits Coordinator to resolve authorization issues.
Works with Admissions and Teams to coordinate forms and patient status.
Assist with admissions and insurance verification coverage as needed.
Attend departmental meetings and webinars.
Generates corrections and re-billing efforts if needed.
Enter write-offs or adjustments as appropriate.
Posts and reconcile all payments and ensure balancing to general ledger each month.
Monitors progress with Aging reports and ensure timely follow up.
Performs other miscellaneous tasks as assigned.
Receives and responds in a timely manner to inquiries from patients, staff, and facilities regarding billing, coding, or related issues.
Works with payers as needed to expedite reimbursement and resolution of claims.
High school diploma required.
CPC – Certified Professional Coder or equivalent certification
2-4 years of medical billing or other medical field-related experience, including Medicare, Medicaid and other third parties required.
3-5 years of general office experience required.