Job Summary: 

• Review medical record documentation to identify all services provided by physicians.
• Assign appropriate CPT-4 procedure codes to accurately report the physician services provided to patients.
• Assign appropriate ICD-9/ICD-10 diagnosis codes to accurately support the need for each physician service.
• Obtain and submit copies of medical documentation with physician charges to support billing to third-party payers.
• Identify physician services provided, but not adequately documented in the medical record.
• Advise supervisor and clinicians of deficiencies to support charge capture of all billing services.
• Analyze and resolve physician claim rejects and denials from the billing system or insurance carriers related to coding issues.
• Follow up to see if a claim is accepted or denied, and investigate the rejected claim to see why the denial was issued.
• Assist with physician billing and documentation training in daily interactions with physicians and other routine training sessions.
• Comply with daily, weekly, and monthly clinic production reports.
• Identify trends/problems in medical documentation and department request issues, and recommend possible solutions.

Skills on Resume: 

• Medical Coding Accuracy (Hard Skills)
• CPT/ICD Proficiency (Hard Skills)
• Documentation Review (Hard Skills)
• Claim Denial Analysis (Hard Skills)
• Billing Follow-Up (Hard Skills)
• Charge Capture Support (Soft Skills)
• Physician Communication (Soft Skills)
• Problem Identification (Soft Skills)

Job Summary: 

• Utilize ICD-10-CPT and HCPCS codes for reporting diagnoses and procedures.
• Ensure progress notes are coded accurately and to the maximum level of specificity following established coding guidelines.
• Ensure receipt of all progress notes, logs, walk-in notes, etc., at the end of the day.
• Work with physicians for coding accuracy.
• Run outstanding encounter report daily to ensure all services have been coded and encounters have been properly closed.
• Inform the administrator of issues pending in the outstanding encounter report that do not pertain to coding.
• Maintain the administrator and the Physician in Charge informed of coding issues.
• Maintain patient confidentiality at all times.
• Follow established policies and procedures.
• Maintain up-to-date on new coding regulations.

Skills on Resume: 

• ICD-10-CPT Use (Hard Skills)
• Accurate Coding (Hard Skills)
• Documentation Receipt (Hard Skills)
• Physician Collaboration (Soft Skills)
• Encounter Review (Hard Skills)
• Issue Reporting (Soft Skills)
• Confidentiality Practice (Soft Skills)
• Policy Compliance (Soft Skills)

Job Summary: 

• Review and adjudicate coding of services from documentation on time.
• Code physician/provider visit procedure notes to identify appropriate ICD-9 and CPT-4 codes for charge processing.
• Ensure that all diagnosis ICD9 codes and procedure CPT, HCPCS codes are identified, sequenced, and coded in an accurate and ethical manner for optimized reimbursement.
• Assign Evaluation and Management codes and key concepts/elements documented in the patient note, utilizing defined coding guidelines applicable to professional and technical.
• Research and identify correct codes for routine, new, or unusual diagnoses and procedures not clearly listed in ICD-9 and CPT guidelines, and the functions of the position.
• Identify all procedures that may require modifiers (including 340B) for billing and reporting.
• Consult with the physician and providers for clarification of clinical data when encountering conflicting or ambiguous information and/or significant missing documentation.
• Track cases with insufficient documentation, ensuring the case does not become appropriately coded and billed.
• Ensure documentation adheres to Federal, State, and County billing policies.

Skills on Resume: 

• Coding Adjudication (Hard Skills)
• ICD/CPT Coding (Hard Skills)
• Accurate Sequencing (Hard Skills)
• E/M Assignment (Hard Skills)
• Code Research (Hard Skills)
• Modifier Identification (Hard Skills)
• Clinical Clarification (Soft Skills)
• Documentation Compliance (Hard Skills)

Job Summary: 

• Perform complex coding and related duties using established Professional Billing Office and Coding Services policies in an accurate and timely manner.
• Review complex and unique medical documentation and system-generated charges or paper encounter forms.
• Appropriately assign CPT®, ICD-9, ICD-10, HCPCS II, and modifiers based on documentation and payor requirements.
• Research complex billing rules and regulations for new and existing procedures.
• Identify, correct, and report coding problems.
• Maintain current knowledge of coding, compliance, and reimbursement procedures.
• Review current literature, newsletters, payor policy updates, and coding manuals.
• Resolve complex coding edits and denials on time.
• Identify opportunities to reduce denials and enhance revenue.
• Provide cross coverage of multiple complex specialties.
• Function as a resource to the Professional Billing Office staff and external customers.
• Research and resolve coding inquiries.
• Make recommendations for coding policy changes.
• Participate in the electronic or paper encounter form revision process to ensure correct coding standards are met.
• Performs quality assurance reviews of all Coding Specialists in areas of expertise.
• Functions as a subject matter expert for assigned specialties.
• Develop and maintain division-specific coding procedures.
• Complete special projects as assigned by management, which require defining problems, determining work sequences, summarizing findings, and implementing required changes.
• Participate in coding education for providers and co-workers.

Skills on Resume: 

• Complex Coding Tasks (Hard Skills)
• Documentation Review (Hard Skills)
• Multicode Assignment (Hard Skills)
• Denial Resolution (Hard Skills)
• Billing Rule Research (Hard Skills)
• Quality Assurance (Hard Skills)
• Subject Expertise (Hard Skills)
• Coding Education (Soft Skills)

Job Summary: 

• Verify that the insurance payer is active and correct for each patient before starting the authorization process.
• Request authorizations from payer sources with accurate documentation required by the payer and submit authorizations using the best possible method (i.e., Fax, web portal, etc.).
• Retrieve authorizations and uploads to the patient’s chart.
• Make sure all visits scheduled are within the date range of the authorization and are associated with the active auth.
• Systematically track authorizations to ensure each date of services is covered by an authorization.
• Communicate any discrepancies or need for documentation to the correct internal/contracted source and obtain what is needed to request authorization.
• Run reports daily and weekly to manage authorizations and to ensure all visits are billed with the correct authorization.
• Assist with billing Medicare and commercial payer claims.
• Assist with other accounts receivable duties, such as collections and/or audits, which may be requested periodically.

Skills on Resume: 

• Insurance Verification (Hard Skills)
• Authorization Requests (Hard Skills)
• Chart Uploads (Hard Skills)
• Auth Date Tracking (Hard Skills)
• Discrepancy Communication (Soft Skills)
• Report Management (Hard Skills)
• Claims Billing Support (Hard Skills)
• AR Support (Hard Skills)

Job Summary: 

• Analyze and code claim information in a timely and accurate manner to ensure quality data and timely review.
• Complete assigned work, ensuring department benchmarks are met or exceeded consistently in accordance with current industry standards and the use of current technologies.
• Maintain professional skills and remain engaged in the goals and vision of the organization to ensure the department functions efficiently and accurately with integrity.
• Actively participate in staff meetings and offer constructive suggestions for improving the process.
• Work with individuals at all organizational levels, particularly peers, team members, other departments, patients, and the community.

Skills on Resume: 

• Claim Analysis (Hard Skills)
• Accurate Coding (Hard Skills)
• Benchmark Achievement (Hard Skills)
• Professional Engagement (Soft Skills)
• Integrity Practice (Soft Skills)
• Process Improvement (Soft Skills)
• Meeting Participation (Soft Skills)
• Team Collaboration (Soft Skills)

Job Summary: 

• Review medical records, patient medical history and physical exams, physician orders, progress notes, consultation reports, diagnostic reports, operative and pathology reports, and discharge summaries to verify whether the diagnosis codes are supported by the documentation and agree with ICD-10 Guidelines for Coding and Reporting.
• Review all medical record documentation.
• Participate in and support internal and external prospective and retrospective reviews and audits.
• Identify training needs, prepare summary reports, and conduct coaching for clinicians and other staff to improve the quality of the documentation to accurately reflect the burden of illness for patients
• Research and resolve coding projects.
• Perform ongoing analysis of medical record charts for the appropriate coding compliance.
• Work quickly, accurately, and independently, meet daily production goals, and achieve a quality goal of 95% accuracy rate.
• Extensively use electronic medical records in an ICD-10 environment.

Skills on Resume: 

• Record Review (Hard Skills)
• Documentation Verification (Hard Skills)
• Audit Support (Hard Skills)
• Training Coaching (Soft Skills)
• Coding Research (Hard Skills)
• Compliance Analysis (Hard Skills)
• Independent Productivity (Soft Skills)
• EMR Utilization (Hard Skills)

Job Summary: 

• Make sure that codes are assigned correctly and sequenced appropriately as per government and insurance regulations.
• Comply with medical coding guidelines and policies.
• Receive and review patients’ charts and documents for verification and accuracy.
• Follow up and clarify any information that is not clear to other staff members.
• Collect information provided by the Physician from different sources to prepare monthly reports.
• Implement strategic procedures and choose strategies and evaluation methods that provide correct results.

Skills on Resume: 

• Correct Code Assignment (Hard Skills)
• Guideline Compliance (Hard Skills)
• Chart Verification (Hard Skills)
• Information Clarification (Soft Skills)
• Data Collection (Hard Skills)
• Report Preparation (Hard Skills)
• Strategic Procedures (Soft Skills)
• Evaluation Methods (Hard Skills)

Job Summary: 

• Review patient medical records and abstract medical data that identifies all diagnoses and procedures.
• Code diagnoses, procedures, and appropriate modifiers from the medical record documentation using ICD-10-CM/PCS, CPT4/HCPCS classification systems.
• Refer to a computerized encoding system, written coding aids, and other reference materials to ensure accurate coding for billing.
• Sequence diagnoses, procedures, and complications by following ICD-10-CM/PCS, CPT-4, the Uniform Hospital Discharge Data Set (UHDDS), adhere to the Official Guidelines for Coding and Reporting, Coding Clinic guidelines, and other regulatory guidelines.
• Consult with the CDCI team to request an appropriate physician or appropriate medical staff to clarify medical record information.
• Assign grouper codes to each record according to patient type and financial class (DRG, ASC, APG, etc).
• Enter coded/abstracted information in the grouper, analyze groupings, and assign the appropriate grouper for appropriate and accurate reimbursement.
• Enter data abstracted information into the Medical Center's computerized database.
• Assist the clinical documentation specialists in medical record documentation auditing.
• Work closely with other coding staff to resolve coding-related issues and denial management
• Maintain productivity standards outlined in Departmental Policies and procedures.
• Contact the Medical Records departments to track missing records so that all records can be billed.
• Maintain knowledge of coding and professional skills, including maintaining yearly coding credentials through attendance at in-service programs, conferences, workshops, review of current literature, and other educational programs.
• Assist in training new personnel in department coding procedures.
• Utilize the hospital's cultural values as the basis for decision-making and to facilitate the hospital's goals and mission.
• Follow established Hospital infection control and safety procedures.

Skills on Resume: 

• Record Abstraction (Hard Skills)
• Diagnostic Coding (Hard Skills)
• Reference Utilization (Hard Skills)
• Code Sequencing (Hard Skills)
• Clinical Clarification (Soft Skills)
• Grouper Assignment (Hard Skills)
• Denial Management (Hard Skills)
• Staff Collaboration (Soft Skills)

Job Summary: 

• Review medical reports and physician documentation for clinic and hospital outpatient services to apply diagnostic and procedural codes to individual patient health information for claims processing, data retrieval, and analysis. 
• Assign codes for ambulatory outpatient services using the International Classification of Diseases (ICD) and Current Procedural Terminology (CPT) coding protocols, for facility and professional services, including professional code entry for Emergency Room and Urgent Care providers. 
• Audit the electronic medical record for accuracy of patient information, insurance information, appropriate diagnosis, and procedure codes to ensure accurate documentation for billing and reimbursement.
• Review and resolve National Correct Coding Initiatives (NCCI) and Outpatient Code Editor (OCE) edits. 
• Communicate with clinical department directors and medical billing staff to clarify coding guidelines and resolve claim edits.
• Identify and communicate missed revenue opportunities to ambulatory departments.
• Work with the business analyst to create new charge codes.
• Investigate denied claims from insurance carriers and appeals timely to ensure accurate reimbursement. 
• Abstract pertinent information from patient records using a hospital information system. 
• Querie physicians to provide clarification on documentation or code assignment. 
• Identity coding concerns or trends.
• Involved Revenue Cycle leadership to assist with the resolution.
• Provide education on coding changes. 
• Attend continuing education programs and review other educational resources to keep current on any changes about this position and for coding recertification. 
• Assist with developing policies and procedures related to coding. 
• Assist in training new employees and job shadowing. 

Skills on Resume: 

• Report Review (Hard Skills)
• Outpatient Coding (Hard Skills)
• EMR Auditing (Hard Skills)
• Edit Resolution (Hard Skills)
• Clinical Communication (Soft Skills)
• Revenue Opportunity ID (Hard Skills)
• Charge Code Creation (Hard Skills)
• Denial Investigation (Hard Skills)

Job Summary: 

• Review and assign accurate CPT, HCPCS, ADA, and ICD-10 codes for diagnoses, procedures, and evaluation and management services performed by physicians and other qualified healthcare providers.
• Practice the correct application of CPT, HCPCS, ADA, and ICD-10 codes when translating written diagnostic and procedural documentation into numerical codes.
• Perform timely prospective/retrospective coding and abstracting functions for charge sessions/denied claims routed to Epic coding work queues.
• Perform regular retrospective documentation and coding reviews for all FRHC departments to ensure that providers are adhering to documentation and coding guidelines.
• Document all coding changes made appropriately within the Epic system and notify the provider via the Epic InBasket messaging system.
• Serve as an on-site billing department resource for coding-related functions.
• Process all assigned charge sessions and review all claims for services rendered to ensure proper billing for reimbursement of services.
• Post insurance and self-pay payments to patients’ accounts and complete the batch reconciliation process.
• Follow up on unpaid claims.

Skills on Resume: 

• CPT/ICD Coding (Hard Skills)
• Accurate Code Application (Hard Skills)
• Claim Coding Review (Hard Skills)
• Documentation Auditing (Hard Skills)
• Epic Coding Updates (Hard Skills)
• Billing Support (Soft Skills)
• Payment Posting (Hard Skills)
• Claim Follow-Up (Hard Skills)

Job Summary: 

• Analyze clinical records and assign correct CPT-4, ICD-10, and/or HCPCS codes, Modifiers, and quantities to the Medical Claim.
• Perform an array of coding and billing audits for multi-specialty clients.
• Use multiple Clearinghouses to transmit claims data and review claims EOBs.
• Communicate with physicians and their office staff regarding ambiguous or conflicting information.
• Research claim denials and rejections, and effectively resolve or overcome these rejections/denials with corrected claims and appeals.
• Complete monthly On-Demand Webinars provided by CMS to ensure knowledge is complete and up-to-date.
• Keep informed and up-to-date with CMS and AMA CPT Guidelines and Policies.

Skills on Resume: 

• Clinical Record Coding (Hard Skills)
• Coding Audits (Hard Skills)
• Clearinghouse Use (Hard Skills)
• Physician Communication (Soft Skills)
• Denial Resolution (Hard Skills)
• Claims Research (Hard Skills)
• Regulation Updates (Hard Skills)
• Guideline Compliance (Hard Skills)

Job Summary: 

• Code physician documentation for risk adjustment, utilizing the current ICD-10 Coding guidelines.
• Assist with providing education on how to document appropriately at the doctors’ offices.
• Train and mentor coding staff to effectively perform their job responsibilities following current coding policies and procedures.
• Assist coders with medical terminology, disease processes, and complex surgical techniques.
• Review medical charts electronically using a computer.
• Abstract and code diagnosis and documentation information.
• Research and resolution of coding projects.
• Document requested information from the medical record.
• Determine valid encounters, including legibility and valid signature requirements.
• Perform ongoing analysis of medical record charts for the appropriate coding compliance.
• Monthly travel to Providers' offices to provide coding education/support.
• Attend conference calls to provide information and/or feedback.

Skills on Resume: 

• Risk Adjustment Coding (Hard Skills)
• Documentation Education (Soft Skills)
• Coder Mentorship (Soft Skills)
• Clinical Terminology Support (Hard Skills)
• Chart Review (Hard Skills)
• Diagnosis Abstraction (Hard Skills)
• Coding Compliance Analysis (Hard Skills)
• Provider Communication (Soft Skills)

Job Summary: 

• Learn about CAN medical specialties and services offered.
• Provide feedback to providers and operational staff regarding denials, payments, coding, etc.
• Maintain communication by facilitating meetings and providing frequent updates.
• Act as a resource for coding questions from a variety of departments, including Revenue Cycle, Clinical Operations, HIM, and EHR Support.
• Assist in troubleshooting and/or conducting research when presented with difficult coding scenarios.
• Analyze supporting medical record documentation for professional services to ensure that appropriate ICD-10-CM, CPT, HCPCS codes are assigned according to established correct coding guidelines and standards of ethical coding.
• Perform ongoing review and tracking of insurance rejections/denials with coding discrepancies, contacting insurance companies.
• Consult with clinical providers for coding and documentation clarification.
• Conduct prospective and retrospective clinical documentation and coding reviews.
• Provide individual and group feedback and education to clinical providers and other staff because of the coding reviews and identified coding trends, in accordance with the established compliance plan.
• When provider documentation issues are identified, work with clinical operations and compliance staff to implement corrective action plans.
• Attend clinic and department staff meetings to disseminate information and to become familiar with operational issues within each business unit.
• Work in conjunction with the clinical operations team to evaluate special requests for review of appropriate coding due to patient complaints, denials, rejections, incorrect coding, etc., and provide feedback to the inquiring source.
• Analyze information about patient treatment, diagnosis, and procedures to ensure proper coding guidelines are met.

Skills on Resume: 

• Medical Specialty Knowledge (Hard Skills)
• Provider Feedback (Soft Skills)
• Communication Updates (Soft Skills)
• Coding Resource Support (Soft Skills)
• Coding Troubleshooting (Hard Skills)
• Documentation Analysis (Hard Skills)
• Denial Tracking (Hard Skills)
• Clinical Consultation (Soft Skills)