About the position
Responsibilities
• Utilizing 3M, CPT, and ICD-10-CM coding books/software to assign CPT and/or ICD-10-CM codes to medical services or charges.
• Completing required research to ensure compliance with CCI edits - CPT and ICD-10 coding standards.
• Utilizing EPIC workflow to review account CCI edits and resolve as appropriate.
• Performing charge reconciliations to ensure all charges are being captured.
• Maintaining updated knowledge of coding requirements, including continuing education and certification renewal.
• Reviewing and performing necessary coding and billing corrections for all insurance coding and medical necessity denials.
• Assisting the billing staff with coding questions.
• Consistently meeting the department specific standards for quantity standard.
• Consistently coding at a 95% accuracy rate or better (quality standard).
• Utilizing Internet and other resources to research newly identified diagnosis and/or other procedures.
• Researching CPT and ICD-10 coding discrepancies for compliance and reimbursement accuracy.
• Acting as a liaison between the denials team, billers, clinical staff, and leadership in resolving billing and reimbursement issues.
• Conducting billing and coding compliance documentation review, which may include review of out-patient medical records to determine appropriateness of procedure and diagnosis coding, as well as evaluation and management coding.
• Conducting analysis and applying state and federal healthcare or related regulations to different questions, projects, or inquiries.
Requirements
• Proficient in using 3M, CPT, and ICD-10-CM coding books/software.
• Strong understanding of CCI edits and coding standards.
• Experience with EPIC workflow for account management.
• Knowledge of medical billing and coding compliance documentation.
• Ability to conduct research on coding discrepancies and newly identified diagnoses.
Nice-to-haves
• Certification in coding (CPC, CCS, etc.).
• Experience in a healthcare setting, particularly in patient accounts or billing.
• Familiarity with federal healthcare regulations.
Benefits
• Opportunity for remote work after initial training period based on productivity levels.
• Collaborative work environment with a focus on diversity, equity, and inclusion.
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