Responsible for aspects of Candidate for Billing (CFB) workflow, reviewing billing and reimbursement policies, and working with RCM managers to improve operations and productivity.
Responsibilities
Manage Candidate for Billing (CFB) workflow including pre-bill buckets, created buckets greater than 7 days, DNBS, STOP BILLS, and claim edits
Reviews CMS, FI and Carrier websites for Bulletin, Transmittals, Program Memorandums, Local Medical Review Policies
Educates and distributes relevant information to the appropriate staff
Works with RCM managers to improve flow of operations
Solves problems and improves productivity for special situations impacting RCM operations
Requirements
High School graduate plus two years additional education in healthcare billing, accounting or business administration, or equivalent work experience
Nice to have: Minimum three years of relevant experience in healthcare
Analyzes documentation in the medical record to obtain information necessary for the appropriate sequencing and assignment of ICD-10-CM and CPT-4 codes.
Responsibilities
Reviews documentation in the medical record to determine ICD-10 CM and CPT-4 coding that is needed to comply with billing and reimbursement guidelines set forth by government entities.
Verifies data in the medical record and accurately abstracts pertinent information for charge entry.
Appropriately utilizes CPT-4 and ICD-10 current procedural coding standards in assisting the provider with proper selection and assignment of the principal procedure(s) and related diagnosis.
Edits unbilled claim transmission reports daily and makes necessary corrections to ensure accuracy and timely billing.
Participates in quality coding and audit reviews for each provider.
The compensation range for the role is $26.44 - $27.23 hourly
Responsibilities
Greets, interviews or telephones patients and/or families or other representatives to obtain necessary demographic and financial information required for reimbursement of all services rendered
Responsible for scheduling procedures/visits for GHMC departments, and accurately obtaining required information for hospital records, governmental requirements, billing, and third-party payer needs
Ensures patients have all necessary information regarding their coverage and benefits related to their visit and informs patients of their financial obligations so that they arrive prepared
Manages work queues, communications with multiple departments, including outside physician offices, collection of deposits, co-pays and balances
Notifies Financial Advocates of any self-pay or uninsured patients
Requirements
High School Graduate with courses successfully completed in Medical/Healthcare studies, or academic studies to include typing proficiently
Reviews/audits and interprets medical record documentation to identify pertinent diagnosis/procedure and apply correct ICD10, CPT-4, and HCPC’s codes in accordance with government and insurance regulations.
Demonstrates appropriate utilization of coding software and coding reference material.
Follow up with providers on any documentation that is insufficient, missing, or unclear.
Assists providers with questions regarding coding and documentation guidelines.
Keeps up to date on carrier policies/guidelines to ensure all coded services meet appropriate Medicare, National Correct Coding Initiative (NCCI) or Payer-specific guidelines.
Requirements
Professional coder certification with credentialing from AHIMA and/or AAPC, must be maintained annually
ICD10 certified and/or extensive work experience
Nice to have: Orthopedic coding experience
Nice to have: high-volume orthopedic and surgical clinics
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