Responsible for the review and coding of complex outpatient and/or ambulatory surgery records utilizing ICD-10-CM, ICD-10-PCS, and CPT coding guidelines for the establishment of diagnoses and procedures for both Professional AND Facility insurance claims. Reviews electronic medical health records in eClinicalWorks (eCW) for completeness and accuracy prior to their release to our outside billing organization. Works closely with said billing organization to troubleshoot and identify the root cause of insurer payment delays, denials, and rejections.
Principal Responsibilities:
- Assigns CPT, HCPCS and ICD-10-CM codes and abstracting of patient encounters, including diagnostic and procedural information, significant reportable elements, and complications.
- Reviews, audits, analyzes and interprets the eCW medical record in its entirety to ensure accurate, complete and consistent selection of diagnoses and procedures to assure the production of quality healthcare data and accurate facility payment.
- Queries physicians for clarification of documentation as deemed necessary.
- Actively participates in the documentation improvement process in conjunction with the CFO and executive leadership.
- Reviews and verifies documentation support for existing diagnoses, procedures and other charges.
- Ensures compliance with CMS and other regulatory compliance guidelines.
- Follows up on open/unlocked Provider case files and ensures readiness for billing within 48-72 hours of date of service.
- Prepares and reviews final EMHR for completeness prior to release to outside billing agents.
- Provides documentation in a timely manner.
- Participates in meetings and training programs as deemed necessary.
- Contributes to the collaboration between providers, finance, exec leadership and the revenue cycle process to ensure fluid communication and more efficient and effective insurer reimbursement.
- Communicates regularly and freely with outside billing organization to troubleshoot case file issues and claim denials.
- Identifies EMHR software and template modifications in order to optimize reimbursement/revenue for discussion and implementation with CFO.
- Assists with training and orientation of staff.
- Other duties as assigned.
Education/Qualifications:
- High School Diploma required.
- Active AAPC Certified Outpatient Coder (COC) or Certified Professional Coder (CPC or CCS) designation or equivalent required.
- Minimum of three (3) years of coding experience with both facility and professional (provider) patient files in an ambulatory surgery setting required.
- Proficiency with eClinicalWorks (eCW) EMHR system required.
- Strong coding experience specifically in the area of women’s health including mental health counseling, OB/GYN, prenatal care, postpartum care, abortion, family planning, bariatric, and podiatry care strongly preferred.
- A.A.S. Degree in Health Information Technology or Health Information Management preferred.
Job Type: Full-time
Benefits:
- Dental insurance
- Health insurance
- Paid time off
- Vision insurance
Schedule:
- Monday to Friday or Tuesday to Saturday work schedule
Work Location: Onsite to start. Hybrid arrangement possible after 6 months
Job Types: Full-time, Part-time
Pay: From $85,000.00 per year
Benefits:
- 401(k)
- Dental insurance
- Health insurance
- Paid time off
- Vision insurance
License/Certification:
- Certified Coding Specialist (Preferred)
Work Location: In person
