• 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 every month

Skills: Coding and Billing Compliance, Policy Formulation and Procedure Development, Quality Control and Auditing, Stakeholder Communication, Problem Identification and Resolution, Training and Education, Fee Schedule and Form Management, Evaluation and Management (E/M) Profiling

• Conducting comprehensive reviews of medical charts for complete and accurate coding
• Reviewing the clinical documentation completed by the providers and querying them for any updates to the medical records based on the highest degree of specificity and accuracy, and ensuring sign-off by providers
• Processing of patient charts and encounters timely.
• Identifying opportunities for more complete documentation of medical encounters based on chart review and analytics provided by software
• Identifying opportunities for reaching optimal Quality performance (i.e. STARS, HEDIS, MIPS) through chart review and development of patient-by-patient quality plans
• Conducting and participating in training/education for providers to instill a culture of excellence related to medical documentation and coding
• Communicating with insurance companies regarding disputes or appeals as it relates to coding
• Conducting audits and coding reviews proactively
• Participating in Quality Assurance and Peer Review processes

Skills: Medical Chart Review and Coding Accuracy, Clinical Documentation Improvement, Timely Processing of Patient Charts, Analytics for Documentation Enhancement, Quality Performance Optimization, Provider Training and Education, Insurance Communication and Appeals Management, Auditing and Quality Assurance

• Coordinate production of annual edit package based on CPT changes/instructions, prepare more complicated issues to discuss with CMS and distribute for review and comment
• Coordinate and assist in development of edit proposals from review of NHO and/or CMS publications, websites
• Assist with creation of change documents and coordinate research related to workgroup discussions and requests
• Serves as non-physician contact for AMA/NHOs/CMS-CO and ROs to answer questions over the phone, through correspondence/emails
• Answer and prioritize correspondence at all levels eg, providers, AMA/NHOs, consultants, Medicare contractors
• Answer questions, produce reports or information for CMS COR or program manager as requested (for OIG, GAO, DOJ, or CMS/CPI/DASG)
• Assist IT in resolving QA discrepancies in QA testing on a quarterly basis with edits and database fields, in modifying test queries or OCE guidelines based on changes in codes or CMS coding policies
• Distribute responses to NHOs, providers for reconsideration requests
• Review New Issue QA and proposal review for RVC

Skills: Project Coordination, Communication Skills, Technical Documentation, Regulatory Knowledge, Quality Assurance (QA) and Testing, Analytical Skills, Research and Data Management, Prioritization and Problem-Solving

• Receives automated and manual tasks alerting to the need for coding of patient assessments.
• Mark tasks as "In Process" as a way to acknowledge and reserve the assessment to prevent premature OASIS submission.
• Adds correct ICD 10 codes to medical records based on a review of clinical data and communication with clinicians.
• Makes corrections based on collaboration with a clinician.
• Identifies viable primary and secondary diagnoses necessary for an accurate plan of care.
• Follows sequencing and reporting procedures mandated by Medicare and other payers for completion of coded data.
• Creates Episode Analysis report and communicates findings with Clinical Manager.
• Maintains up-to-date OASIS assessment and home health coding knowledge.
• Ensures review time from the date received does not exceed 24-48 hours during normal business hours.
• Meets minimum productivity requirements of 12-15 reviews per day upon completion of an appropriate orientation period.
• Contributes to team effort by accomplishing related results

Skills: ICD-10 Coding Proficiency, OASIS Assessment Knowledge, Clinical Data Review, Compliance with Reporting Procedures, Effective Communication, Time Management, Productivity and Efficiency, Team Collaboration

• Assess clinical documentation submitted by physician practices that support clinical services. 
• Using the ICD-10 manuals, review medical reports to identify the diagnosis indicated recommending appropriate ICD-10 codes by the University Billing Compliance Department, the Healthcare Financing Administration, Medicaid, and other regulatory and professional organizations in the Department.
• Develop and revise encounter forms and documentation templates under the direction of the Billing Compliance Director.
• Review ETM Coding Edits in IDX on a daily basis. 
• Make the necessary coding changes as requested in edit and release charges for timely billing
• Responsible for preparing monthly reports of all pre-billing transaction reviews and will coordinate the development of reporting systems to promptly address and correct compliance issues.
• Maintain and Reconcile MD Audit used for the performance of Physician review through MD Audit. 
• Follow up with physicians and clinical practice staff in order to clarify documentation and follow up on compliance issues.
• Code Interventional Radiology for in-patient services through CROWN charges. 
• Review charges and append appropriate evaluation and management consult codes when necessary.
• Review Billing Office Coding logs submitted for coding review and respond in Excel spreadsheets for timely action on the claim.

Skills: ICD-10 Coding Expertise, Medical Documentation Review, Encounter Forms & Documentation Templates, ETM Coding Edits Management, Reporting and Compliance Management, MD Audit Reconciliation, Physician and Staff Communication, Interventional Radiology Coding

• Performs chart audits for clinical documentation and coded data to validate documentation supports services rendered for reimbursement and reporting purposes.
• Interprets progress notes, encounter summaries, and other chart documentation to determine services provided and accurately assign CPT, CPT II, HCPCS, ICD-10-CM and ASA codes CPT to these services.
• Performs analysis to identify discrepancies, potential quality of care, and/or billing issues
• Works with clinical and quality leadership on findings.
• Communicates with physicians and other parties to clarify information such as discussing procedures and other services billed to ensure proper and accurate coding.
• Examine documents for missing information
• Ensuring documents are grammatically correct and free from typing errors.
• Collaborates with the Lead Physician on provider orientation, training and mentoring related to medical coding or complete documentation.
• Reviews all physician documentation to ensure compliance with third party and regulatory guidelines including medical coding policies and guidelines.
• Serves as a resource and subject matter expert to other Spira Care Center staff and Operations staff.
• Performs duties and job functions in accordance with the policies and procedures established for the department including special projects 

Skills: Medical Coding and Documentation, Chart Audits, Analytical Skills, Compliance and Guidelines, Communication, Error Detection, Training and Mentoring, Subject Matter Expertise

• Conduct audits and coding reviews to ensure all documentation is accurate
• Reviews and verifies documentation supports coding.
• Assign and sequence all codes for professional services rendered
• Collaborate with department to ensure claim accuracy standards in a timely manner
• Serves as a resource and subject matter expert to other team members as well as clients, demonstrating solid communication and customer service skills.
• Query physicians and other health care professionals with questions regarding coding and documentation standards.
• Adhere to all regulatory and federal compliance rules and regulations
• Maintain professional development (CEUs) and knowledge of up-to-date coding and regulatory information.
• Translates medical terminology into numerical codes that represent an accurate diagnosis and procedure for each patient encounter
• Reviews the codes assigned by Clinicians to assure appropriateness and accuracy, assuring that sufficient documentation exists to substantiate codes selected
• Works effectively with members of the Patient Accounts Department to facilitate billing of services provided

Skills: Audit and Coding Review Expertise, Code Assignment and Sequencing, Claim Accuracy and Collaboration, Subject Matter Expertise, Regulatory Compliance, Medical Terminology Translation, Documentation Verification, Patient Accounts Coordination

• Experience in training in coding/abstracting procedures, anatomy and physiology and medical terminology obtained through seminars and college courses.
• Direct billing or collections experience in a healthcare or insurance environment. 
• Knowledge of Completion of medical billing and coding course and coding certification
• Experience with CPT and ICD10 coding.
• Knowledge of collection procedures, laws, rules, and regulations
• Skill in written and oral communications
• Skill in performing arithmetic calculations
• Active AAPC certification
• Additional coding certifications applicable to physician practice billing preferred
• Ability to concentrate and pay close attention to detail.
• In-depth knowledge of the latest OASIS version, Medicare guidelines, and home health standards.
• Proficiency with Microsoft Office (Word, Excel, PowerPoint, Outlook).

Qualifications: BA in Health Information Management with 3 years of Experience

• Knowledge of registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT) or Certified Professional Coder (CPC) certification or Certified Coding Specialist (CCS).
• Experience with organization's coding test.
• Experience with physician coding.
• Experience in "hands-on" patient care, and basic knowledge of pathology and etiology of disease, body areas and organ systems.
• Knowledge of certificate for completion of a Medical Terminology course, or related course study that included a Medical Terminology module.
• Clinical experience with a focus on anatomy and/or physiology, or a satisfactory combination of education and related work experience.
• Strong understanding of medical terminology.
• Experience in emergency Medicine coding
• CPC (Certified Professional Coding) Certification through AAPC or CCS or CCS-P (Certified Coding Specialist, Certified Coding Specialist-Professional) or RHIT (Registered Health Information Technician) or RHIA (Registered Health Information Administrator) certification through AHIMA
• Experience in medical or behavioral coding 
• Clerical experience working in a health care organization or in a position that requires understanding and application of basic accounting principles
• Experience in medical or behavioral coding.

Qualifications: BS in Computer Science with 5 years of Experience

• Knowledge of education in ICD-10-CM coding, CPT-4 coding, and medical terminology.
• Knowledge of certification as a Certified Coding Specialist-Physician (CCS-P) through AHIMA (American Health Information Association), or certified by AAPC (American Association Professional Coders) with certification as a Certified Professional Coder (CPC).
• Experience in ICD-9-CM coding 
• Experience in CPT-4 coding 
• Experience with Physician Office billing software
• Experience with physician office billing
• Knowledge of ICD-10, CCS, RHIT, or an RHIA credential through AHIMA or a CPC/CPC-H credential from the AAPC.
• Experience in medical coding.
• Strong analytical skills, excellent interpersonal and communication skills
• Capable of producing detailed, comprehensive documentation and reports.
• Experience in coding or medical billing quality control

Qualifications: BA in Medical Billing and Coding with 4 years of Experience

• Knowledge of certified or Eligible for certification such as CPC, CCS-P, CPC-A
• Knowledge and experience in ICD-10, CPT and HCPCS coding or successful completion of related college course
• Knowledge of Medical terminology certificate or demonstrated 
• Demonstrated knowledge of third-party billing
• Show proficiency in current billing software
• Excellent organizational and communication skills
• Ability to work independently and as part of a team
• Knowledge of Completion of basic coding courses from an AHIMA or AAPC-accredited program
• Experience coding ICD-10-CM, CPT-4
• Experience working in EPIC or other electronic health record management software
• Proficiency is demonstrated by a score of at least 80% or greater on the MLHS coding assessment.

Qualifications: BS in Information Technology with 3 years of Experience

• Knowledge of medical terminology and human anatomy
• Basic office skills including proficiency in Microsoft Word, Excel and Outlook
• Strong communication skills
• Detail-oriented with good problem-solving skills
• Ability to open to new learning 
• Experience in medical coding (both CPT & ICD-10)
• Experience with Meditech, Groupcast (GPMS), & PowerPath
• Knowledge of 3M coding software
• Knowledge of  AAPC or AHIMA certification
• Experience in home health coding 
• Knowledge of ICD-10 certification

Qualifications: BA in Health Informatics with 2 years of Experience

• Direct experience coding Photoshop files for email HTML.
• Strong experience in HTML/CSS, JavaScript and responsive email design
• Ensure rendering consistency of email campaigns in webmail and app-based email clients (Gmail, Outlook.com, iOS Mail, Windows Mail, etc.)
• Working knowledge of Photoshop and Adobe Creative Suite
• Familiar with email and design principles & best practices
• Excellent communication skills and exceptional attention to detail
• Ability to troubleshoot and resolve rendering issues in email code
• Experience in communicating effectively and working closely with the email team, marketing team, and QA
• Experience in prioritizing workload to meet daily deadlines in a fast-paced environment and manage multiple projects simultaneously
• Experience in optimizing graphic elements in the design process for desktop and mobile

Qualifications: BS in Software Engineering with 4 years of Experience

• Knowledge of Certified Professional Coder
• Experience in a medical background
• Proven understanding of the explanation of benefits forms, claim forms, and the insurance billing process.
• Working knowledge of managed care, commercial insurance companies, Medicare, Medicaid and Workers Compensation.
• Experience summarizing account status for management.
• Proven understanding of CPT coding and ICD-10 coding.
• Good communication and verbal skills.
• Knowledge of grammar and spelling.
• Knowledge of medical terminology
• General computer knowledge and typing skills.
• Knowledge of Certification by an HCS-D or AAPC and HCS-O or COS0C program
• Knowledge of certification eligible and obtaining certification within six months of accepting the position.

Qualifications: BA in Healthcare Administration with 5 years of Experience