Insurance and Coding Coordinator - North Little Rock, United States - Arkansas Hospice, Inc.

Description

Job Description

Full-and Part-Time Employee Benefits

Medical, Dental, and Vision Insurance Cancer plan.

401(k) retirement plan with matching Accident plan.

Paid time off (PTO) program Critical life events plan.

Tuition and certification reimbursement Employee Assistance Program (EAP).

Group Term Life Insurance and AD&D Free parking at all locations.

Short term and Long term disability Mileage reimbursement for company travel.

Un-reimbursed medical and dependent care.

POSITION SUMMARY

The Insurance and Coding Coordinator is responsible for insurance verification and collection of deductibles, co-pays and coinsurance amounts owed by Arkansas Palliative Care (APC) and Arkansas Advanced Care (AAC) patients both pre- and post-care. Assigns appropriate ICD-10-CM, CPT, and HCPCS code(s) to patient health information, as documented in the electronic medical record, for data retrieval, data analysis, and proper reimbursement. The position also provides clerical support to the APC and AAC programs. Responsibilities include working on admissions, discharges, collections of patient liabilities (both pre- and post-care), appropriate coding of claims, and various data collection activities in coordination with the APC and AAC clinical team and other Arkansas Hospice (AH) departments.

The Insurance and Coding Coordinator is responsible for all third-party payors including Medicare, Medicaid, private insurance and self-pay as well as collection or patient liabilities (e.g., deductibles, co-pays, co-insurance, etc.) for APC and AAC services.

Maintains records, performs data entry, and participates in other projects and functions as assigned, including education for providers. Maintains positive relations with commercial insurance carriers, obtaining authorizations from commercial insurance companies (including Medicare Advantage, as well as other primary and secondary carriers), ensures all medical management requirements are met for each commercially insured or managed care patient, and facilitates effective communication between the insurance company and APC/AAC regarding each patient's care.

QUALIFICATIONS

Education: High school diploma or GED. CCS, CCS-P, CPC or CPC-A coding credential required.

Experience: A minimum of two (2) years of experience in a clerical role in a health care environment. Must have experience in the assignment of ICD-10-CM, CPT, and HCPCS codes to medical record documentation. Expert knowledge of coding principles and guidelines related to regulatory compliance.

Proficiency in Microsoft Office applications, including Word, Excel and PowerPoint required. Minimum typing speed of 45 wpm.

Additional Requirements: Must have valid driver's license, automobile insurance, personal vehicle, and ability to travel between locations and work flexible hours.

PRIMARY RESPONSIBILITIES

1. Completes all internal collection efforts and responsibilities for APC and AAC as assigned.
2. Follows any changes to a patient's account daily by reviewing and documenting in a timely manner. Also, review Coordination Notes and complete Administrative Tasks in the Electronic Medical Record (EMR).
3. Communicates with physicians' offices, hospitals, insurance companies, and other providers or patients to obtain required information on patient billing sources.
4. May need to educate clinical staff on the choice of appropriate ICD-10-CM codes based on their clinical documentation, in order to meet regulatory guidelines and support maximum reimbursement. Discusses alternative codes and possible additional documentation as wells as educates staff, as needed.
5. Prior to admission, verifies insurance coverage, obtains authorizations, ensures fulfillment of any utilization management requirements, and collects deductibles, co-pays and coinsurance amounts from the patient/responsible party per insurance verification.
6. Responsible for charge entry within EMR. Coordinates and clarifies with providers, when necessary, on information that seems incomplete or is lacking for proper account/claim adjudication.
7. Submits required information to Finance to allow proper daily payment posting to patient accounts.
8. Responsible for verifying and correcting if necessary all payer codes.
9. Analyzes and interprets any denials or rejected claims in coordination with Finance to ensure all claims are accurately sent to all payers.
10. Performs follow-up in coordination with Finance with all third-party payors and patient/responsible party, as applicable, on unpaid insurance accounts identified through aging reports and processes appeals online or via paper submission.
11. Assists Finance in reconciling deposits and patient collections.
12. Assists with billing audit-related information, handles billing calls and questions from patients and third-party carriers.
13. Identifies trends and carrier issues relating to billing and reimbursements. Reports findings to Team Lead, Finance, and/or Supervisor.
14. Maintains documentation of all information gathered, contacts, and negotiations, and documents information required for patient care or billing in the EMR.
15. Assists with verifying that the correct CPT, HCPCS and ICD-10's has been entered and maintained in the EMR appropriately. Different commercial insurance companies may require a different bill type, or a specific CPT or HCPCS code for payment, alongside HIM Coders.
16. Ensures compliance with all applicable state and federal laws, regulatory standards, contracts and organizational policies and procedures, etc.
17. Accepts direction and follows instructions from supervisor; seeks additional information as needed; works with minimal supervision.
18. Upon admission to an APC or AAC service, obtains the hospital or other facility Face Sheet if the patient is in a facility (or required demographic information for non-facility patients)
19. Coordinates with appropriate partner organization staff to ensure consult orders are in the partner organization's EMR and the consult order is added.
20. Maintains statistical database for APC & AAC and partner organizations by compiling and reconciling visit, quality, and other data between systems for reporting purposes.
21. Captures PQRS, CAPC and other data (such as quality and performance metrics) through data mining and/or audits of the appropriate EMR; record and report data; enter data into appropriate system accurately and within specified timeframes.
22. Completes special projects as assigned by Supervisor, Director or CMO.
23. Adheres to all organizational and departmental policies and procedures.
24. Continually meets organizational standards for attendance and punctuality; notifies supervisor in a timely manner when employee will be absent or late for work.
25. Attends all required meetings and in services; seeks opportunities for additional professional development activities as appropriate.
26. Performs other duties as assigned.

COMPETENCIES, KNOWLEDGE, SKILLS, AND ABILITIES

THIS SECTION DESCRIBES WHAT KNOWLEDGE, SKILLS AND ABILITIES AN EMPLOYEE IN THIS POSITION SHOULD CURRENTLY POSSESS. THIS LIST MAY NOT BE COMPLETE FOR ALL KNOWLEDGE, SKILLS AND ABILITIES REQUIRED FOR THIS POSITION.

1. Knowledge of basic computer software applications.
2. Excel knowledge.
3. Skill in organizing and prioritizing workloads to meet deadlines.
4. Ability to communicate effectively both orally and in writing.
5. Ability to communicate effectively with co-workers and other customers.
6. Ability to follow basic safety policies and procedures.
7. Ability to use good judgment and to maintain confidentiality of information.
8. Ability to work as a team player.
9. Ability to demonstrate tact, resourcefulness, patience and dedication.
10. Ability to accept direction and adhere to policies and procedures.
11. Ability to work in a fast-paced environment and manage multiple priorities.
12. Knowledge of nursing practice, documentation, and medical terminology
13. Knowledge of insurance benefit plan design, eligibility and utilization/case management processes.
14. Ability to document in and retrieve information from the electronic medical record and billing system.
15. Ability to assess patients and interpret clinical information to ensure accurate and complete exchange of information with commercial insurance case managers.
16. Competent in the use of numeric and alphabetic filing systems.
17. Competent in the use of electronic medical records systems.
18. Competent in the use of Microsoft Office applications including Word, Excel and PowerPoint.
19. Knowledge of the billing process as it relates to coding for provider services in various settings.
20. Knowledge of medical terminology, anatomy and physiology.
21. Skill in organizing and prioritizing workloads to meet deadlines.
22. Ability to communicate effectively both orally and in writing with co-workers and other customers.
23. Ability to follow basic safety policies and procedures.
24. Ability to use good judgment and to maintain confidentiality of information.
25. Ability to work as a team player.
26. Ability to demonstrate tact, resourcefulness, patience and dedication.
27. Ability to accept direction and adhere to policies and procedures.
28. Ability to work in a fast-paced environment and manage multiple priorities

Performs the above listed functions while regularly working with confidential and/or proprietary Arkansas Hospice and patient information, including but not limited to patient medical records, current or former employee information, Arkansas Hospice records, and other information that the employee regularly uses to perform job functions.