Billing and Coding Specialist - Houston, United States - Advanced Diagnostics Healthcare System
Description
JOB SUMMARY
The Billing & Coding Specialist in this position will analyze patient accounts and review chart notes, review reports, identify areas of deficiencies and make determinations regarding physician accuracy and education needs.
The Billing & Coding Specialist will demonstrate a high level of professionalism, customer service, and interpersonal skills and operates under strict confidentiality guidelines.
DUTIES AND RESPONSIBILITIES
- Maintains current knowledge of the basic and major medical, behavioral health, and prescription coverage plans.
- Maintains current knowledge associated with the billing methodologies of each plan.
- Performs insurance coverage and grant eligibility verifications by making field calls or using other verification tools.
- Compiles billing data from electronic health record system, practice management systems, and other databases.
- Utilizes the encoder or coding books to correctly assign all ICD10CM, ICD10PCS, and CPT codes for diagnosis and procedures.
- Sequences diagnosis and procedures to generate appropriate ICD10CM, CPT, PCS, and DRG codes for billing.
- Queries physicians to obtain clarification or missing elements in the record to be sure of correct coding.
- Utilizes other available resources for assignment of codes as necessary (e.g., Athena, Epic, MIQS, Cardio IMS, Logician, and coding reference materials).
- Demonstrates the ability to interact with others in a way that gives them confidence in one's intentions and those of the organization.
- Completes abstracts for records when appropriate. Checks discharge disposition and attending physician for correctness.
- Provides ICD10 and CPT codes for Business Services and physician office requests regarding nonbilled or nonreimbursed claims.
- Answers inquiries from outpatient clinics and ancillary departments for appropriate assignment of ICD9CM and CPT codes.
- Reviews coding denials to ensure coding is accurate per provider documentation.
REQUIREMENTS
- Two (2) years related experience preferably in an acute care hospital setting.
- Knowledge of Athena, Epic or similar software, highly desired.
- Must have paid experience with medical claims coding/billing and medical insurance industry.
- Will consider 58+YRS EXP if noncertified.
EDUCATION
- High School Diploma or GED
- Some College, Associates, or Bachelor's preferred.
CERTIFICATION, LICENSURE
(one of below)
- CCA
- Certified Coding Associate by the American Health Information Management Association (AHIMA)
- CCS
- Cert-Cert Coding Specialist by the American Health Information Management Association (AHIMA)
- CCS-P
- Cert-CCSP Physician Based by the American Health Information Management Association (AHIMA)
- CIPC
- Certified Inpatient Coder by the American Academy of Professional Coders (AAPC)
- COC
- Certified Outpatient Coder by the American Academy of Professional Coders (AAPC)
- CPC
- Cert-Cert Professional Coder by the American Academy of Professional Coders (AAPC)
- CRC
- Cert Risk Adjustment Coder by the American Academy of Professional Coders (AAPC)
- RHIA
- Cert-Reg Health Inform. Admins by the American Health Information Management Association (AHIMA)
- RHIT
- Cert-Reg Health Inform. TECH by the American Health Information Management Association (AHIMA)
KNOWLEDGE SKILLS & ABILITIES
- Extremely conscientious with excellent organizational skills.
- Capable of working independently and as a team member.
- Must be very customer service oriented.
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