Job Summary:

• Reviews/queries, assigned fee tickets documentation to ensure proper ICD-10 and CPT coding for every charge submitted, including proper linking ICD-10 codes.
• Abstracts and codes by body system, organ, etiology and morphology.
• Applies CPT 4, ICD-10- CM, HCPCS and modifiers.
• Provides feedback to physicians on revenue opportunities, documentation and compliance standards.
• Work with departments to optimize reimbursement, ensure charge capture, reduce late charges and provide feedback to providers.
• Answer customer calls.
• Enters charges into the applicable billing system.
• Works directly with physicians and clinical staff.
• Communicates effectively with others
• Refers all coding/billing inquiries from internal or external sources to the coding supervisor.

Skills on Resume: 

• Medical Coding Knowledge (Hard Skills)
• Attention to Detail (Hard Skills)
• Revenue Cycle Management (Hard Skills)
• Compliance and Documentation (Hard Skills)
• Communication (Soft Skills)
• Customer Service (Soft Skills)
• Data Entry and System Navigation (Hard Skills)
• Problem Solving and Escalation (Soft Skills)

Job Summary:

• Monitoring and working work queues/dashboard for assigned providers and specialties, including coding, researching, correcting claims and trending of coding/billing behaviors.
• Code all documented professional services provided in both clinic and other facilities
• Applies CPT-4, ICD-10-CM, HCPCS and modifiers following coding guidelines
• Adheres to official coding guidelines, AMA and CMS
• Expert in reviewing assigned providers/specialty areas and preparing educational communication, supporting documentation, etc. for provider and other Team coding/billing inquires
• Ensures coded services, provider charges and medical record documentation meet appropriate guidelines and standards
• Keeps abreast of coding guidelines and reimbursement reporting requirements
• Fields coding questions and ensures review of patient complaints as well as insurance inquires on behalf of assigned providers and specialties
• Ensure timely charge review/processing of daily submissions
• Works collaboratively with Team to ensure monthly goals are met

Skills on Resume: 

• Coding Proficiency (Hard Skills)
• Medical Documentation Compliance (Hard Skills)
• Educational Support and Communication (Soft Skills)
• Claims Management (Hard Skills)
• Regulatory and Guideline Updates (Hard Skills)
• Problem Solving and Inquiry Response (Soft Skills)
• Collaborative Teamwork (Soft Skills)
• Charge Review and Processing (Hard Skills)

Job Summary:

• Creating/updating reference tools for assigned specialties (tip sheets/coding guidelines, etc.)
• Provides feedback to physicians related to documentation issues and/or revenue opportunities
• Queries physicians when code assignments are not straightforward or documentation in the record in inadequate, ambiguous, or unclear for coding purposes
• Utilize appropriate application/methods to ensure all documented professional services are submitted timely
• Work on assigned coding projects and compile summary reports
• Identify/trend/summarize potential compliance, coding, billing concerns and bring forth a potential resolution
• Use of computer / other applications, including phone
• Review and analysis of inpatient medical record documentation
• Apply ICD-10-CM and ICD-10-PCS diagnosis and procedure codes to render appropriate reimbursement and meet regulatory coding requirements for inpatient services
• Focus on Medical and Surgical encounters, and supporting the coding of Behavioral Health, Rehabilitation, Newborn and Obstetric encounters
• Work Inpatient Billing and CHIME Edits.

Skills on Resume: 

• Medical Coding Proficiency (Hard Skills)
• Documentation Review and Analysis (Hard Skills)
• Physician Collaboration and Training (Soft Skills)
• Development of Reference Materials (Hard Skills)
• Project Management (Soft Skills)
• Compliance and Issue Resolution (Soft Skills)
• Technological Proficiency (Hard Skills)
• Edit and Denial Management (Hard Skills)

Job Summary:

• Reviews charge that interface from E M R for coding accuracy and compare to medical records.
• CPT code assignment, HCPC assignment, and modifier assignment
• Ensuring ICD-10 code is coded to the highest level of specificity.
• Review the patient's medical record for any missing charges.
• Performs accurate charge entry for billing purposes.
• Compares medical record documentation with charges and ensures accuracy.
• Contact the provider if documentation is missing or any orders are not complete.
• Works directly with medical staff to resolve coding issues and associated problems.
• Communication can be sent to providers via EMR for any changes when the coding or documentation
• Develops and participates in educational activities, including meeting with providers to review provider learning opportunities.
• Maintains strictest confidentiality and follows HIPAA compliance.
• Review coding-related denials to determine how to resolve denial in order to maximize reimbursement.

Skills on Resume: 

• Medical Coding (Hard Skills)
• ICD-10 Coding Accuracy (Hard Skills)
• Charge Review and Entry (Hard Skills)
• Documentation Review and Compliance (Hard Skills)
• Communication and Collaboration (Soft Skills)
• Educational Development (Soft Skills)
• Denial Management (Hard Skills)
• Confidentiality and Compliance (Soft Skills)

Job Summary:

• Provide guidance and instruction regarding insurance coding protocol to ensure compliance with regulatory requirements.
• Serve as a technical resource for all coding and billing regulations for provider services
• Assist in formulating policies and procedures regarding coding and billing to ensure consistency and compliance across all clinic departments
• Interact with medical staff and clinic staff to ensure quality and consistency with coding and billing policies
• Perform quality control reviews of internal audits
• Work with designated clinic administrative staff in identifying and addressing significant coding/billing issues
• Initiating policy changes and/or identifying areas in need of corrective action plans and assist in the development and execution of actions plans
• Education and training of clinic staff and medical staff
• Review and update clinic fee schedule on an annual basis
• Review and update of encounter forms/charge tickets on an annual basis
• Perform Evaluation and Management (E/M) profiling on a monthly basis

Skills on Resume: 

• Expertise in Coding and Billing Regulations (Hard Skills)
• Policy Development and Implementation (Hard Skills)
• Quality Control and Auditing (Hard Skills)
• Training and Education (Hard Skills)
• Policy Analysis and Improvement (Hard Skills)
• Communication and Collaboration (Soft Skills)
• Fee Schedule Management (Hard Skills)
• Evaluation and Management (E/M) Profiling (Hard Skills)

Job Summary:

• Utilizes performance feedback to enhance coding skills. 
• Demonstrates aptitude for basic code assignment and problem-solving
• Assigns ICD-10-CM and CPT-4 codes according to the Official Guidelines for coding and reporting. (Including AHA, AMA, AHIMA, CMS, NCHS, and MLHS specific guidelines)
• Adheres to HIM policies regarding diagnosis and procedure code assignment and abstraction.
• Accurately abstracts selected data elements from each record into the clinical management system to ensure the accuracy of various hospital databases.
• Informs management of any issues or concerns regarding documentation in the medical record.
• Collaborates with coding peers and management to ensure all cases are coded within timeframes specified in the Main Line Health guidelines.
• Maintains a coding compliance score of 92% to 95%.
• Maintains DRG and/or APC accuracy rate of 95% to 97%.
• Maintains established productivity standards. 
• See HIM Policy 7.8 Coding Productivity Guidelines.
• Attends mandatory educational sessions and earns 10 continuing education credits per calendar year.

Skills on Resume: 

• Advanced Coding Skills (Hard Skills)
• Problem-Solving Aptitude (Soft Skills)
• Adherence to Guidelines (Hard Skills)
• Data Accuracy (Hard Skills)
• Documentation Management (Soft Skills)
• Team Collaboration (Soft Skills)
• Compliance and Accuracy Maintenance (Hard Skills)
• Continuing Education (Hard Skills)