Medical Coder | Alabama Talent Triad

11-50 employees

Health Science

Other

Contract

In person

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Required skills

Identifies and clarifies user needs (internal and external customers) and organizational policies to ensure system architecture and applications are in line with business requirements
Adheres to current regulations and establish guidelines in code assignment (focus on assignment of principal diagnosis, principle procedure, and sequencing as well as other clinical coding guidelines
Reviews the Explanation of Benefits/ Remittance Advice
Bills different healthcare physicians and specialties in an outpatient, inpatient, home health and hospice setting. Bills for: Ambulance, Anesthetists, Ambulatory Surgical Centers (ASC), Chiropractic, Durable Medical Equipment (DME), Laboratory (outpatient and inpatient), Radiology (outpatient and inpatient), Mental, Nurse Practitioners, Optometrist, Physicians, Physician Assistants, Podiatrists, Rural Health Clinics, Therapy Services, Home Health,Hospice Health Service
Specifies, refines, updates, produces, and makes available a formal approach to implement information and communication technology solutions necessary to develop and operate the health information system architecture in support of the organization
Ensures that assignment of benefits has been authorized by the patient and is identified in the consent to treatment and on the CMS/HCFA-1500 claim form or UB- 04 claim form.
Compiles patient data and performs data quality reviews to validate code assignment and compliance with reporting requirements
Resolves discrepancies between coded data and supporting documentation
Correctly scans patients’ insurance and identification cards, as well as reads and accurately enters information on these cards, into the Electronic Medical Record (EMR) system.
Maintains appropriate technology solutions including health information systems to support health care delivery and organizational priorities.
Ensures the appropriate documents by use of Subject, Objective, Assessment, and Plan (SOAP) notes, which are located in the patient’s Medical Record. These include History and Physical, as well as Medical Decision Making with the appropriate code level for Evaluation and Management for each individual visit.
Creates effective Appeal Letters
Ensures medical codes reflect medical record documentation.
Enters demographic, insurance, and physician name and physician numbers, and proper coding on the CMS 1500 form and UB-04 claim form.
Follows procedures for appealing billing disputes
Stays apprised of system upgrades for integration of new technology into existing products, applications, or services
Validates coding accuracy using clinical information found in the health record
Ensures that medical records are complete, including medical history, care or treatment plans, tests ordered, test results, diagnosis and medications taken
Ensures compliance with healthcare law, regulations and standards related to information protection, privacy, security and confidentiality
Supports accurate billing through coding, charge master, claims management, and bill reconciliation processes
Ensures that the appropriate insurance authorization, if applicable, is documented in the medical record.
Properly appeals for denial of billing and coding charges.
Uses established guidelines to comply with reimbursement and reporting requirements such as the National Correct Coding Initiative and others
Participates in compliance (fraud and abuse), HIPAA (Health Insurance Portability and Accountability Act of 1996), and other organization specific training
Maintains accurate and complete patient health records
Uses all insurance payers’ websites to review appropriate charging per billing and coding guidelines
Uses cms.gov website to review quarterly updates on established guidelines and regulations for medical billing and coding of claims
Applies policies and procedures to comply with changing regulations among various payment systems for healthcare services, such as Medicare, Medicaid, managed care, etc.
Ensures Current Procedural Terminology (CPT) codes are in standard billing and coding guidelines according to Local and National Determination Coverage.
Verifies consistency between diagnosis and treatment plans, procedures, and services
Ensures accuracy of diagnosis/procedural groups such as DRG (Diagnosis Related Group), MSDRG (Medical Severity), APC (Ambulatory Payment Classification), etc.
Follows procedures for appealing inappropriate coding
Properly audits for appropriate documentation and medical charts, as well as billing codes and procedures
Communicates with physicians or other care providers to ensure appropriate documentation
Supports documentation of care for services provider reimbursement process to ensure timely and accurate payment.
Enters information manually on forms in the event of a physician office of hospital downtime
Enters or confirms code(s) associated with medical diagnosis(es), procedures, and services.
Applies policies and procedures for the use of clinical data required in reimbursement and prospective payment systems (PPS) in healthcare delivery