GENERAL DESCRIPTION OF THE DUTIES:
Reports to the Chief Medical Officer. Performs medical coding assistance as required for Southside Medical Center, Inc. but also concentrates on the evaluation and improvement of processes for optimized and compliant Health Information Management (HIM).
DETAILED DESCRIPTION OF POSITION DUTIES:
- Recommends appropriate charge capture work flow or service posting steps to ensure accurate revenue generation, and may discuss the assignment of specified codes for medical diagnoses and/or clinical procedures with physicians or other providers.
- Interacts with physicians and other providers regarding billing and documentation policies and procedures.
- Analyzes and interprets patient medical records to identify and determine amount and nature of billable services; assigns and sequences appropriate diagnostic/procedure billing codes in compliance with requirements of third party payor requirements
- Requires learning and understanding all aspects of Federally Qualified Health Center (FQHC) coverage, coding, billing, and reimbursement of patient services, as well as medical specialties provided by Southside Medical Center (Pediatrics, OB/GYN, Optometry, Internal (Adult) Medicine, Podiatry, Mental Health Services, Dental, Surgery (General), Infection Diseases).
- Interacts with physicians and other patient care providers both orally and in writing regarding billing and documentation policies, procedures, and regulations to ensure receipt and analysis of all charges; obtains clarification of conflicting, ambiguous, or non-specific documentation; as well as with Department leaders regarding implementation of new codes and revision of charge documents.
- Monitors billing performances to ensure optimal reimbursement while adhering to regulations prohibiting unbundling and other questionable practices; prepares periodic (at least monthly) reports for clinical staff identifying unbilled charges due to inadequate documentation; and researches inquiries from providers and patients about fees, reimbursements, and denials.
- Follows established departmental policies, procedures, and objectives, continuous quality improvement objectives, and safety and environmental standards.
- May attend one (1) coding conference or workshop with consideration for a second per year related to personal coding credentialing to receive updated coding information and changes in coding and/or regulations. Agenda to be evaluated for attendance approval.
- Maintain required continued education for recertification.
- Performs miscellaneous job-related duties as assigned.
KNOWLEDGE, SKILLS AND ABILITIES:
- Knowledge of legal and policy constraints regarding patient care charts and histories to produce accurate patient billing for appropriate quality outcomes.
- Ability to gather data, compile information, and prepare reports utilizing knowledge of auditing concepts and principles, as well analyzing complex medical records with good knowledge of medical terminology.
- Knowledge of current and developing issues and trends in medical coding procedures requirements with the ability to clearly communicate medical information to professional practitioners and/or the general public.
- High school diploma or GED and at least 5 years of experience directly related to the duties and responsibilities specified.
- Certified or Associate Degree in medical Coding or Related Field.
- Completed degree(s) from an accredited institution that are above the minimum education requirement may be substituted for experience on a year for year basis.
- Current coding certification by AHIMA or AAPC.
TYPICAL PHYSICAL DEMANDS:
No or very limited physical effort required. No or very limited exposure to physical risk.
TYPICAL WORKING CONDITIONS:
Work is normally performed in a typical interior/office work environment.