In collaboration with billing Vendor, oversees and assists with coding related pre-bill edits that require CPT's, ICD10, HCPCS and/or Modifiers to release claims to third party payers. Reviews and participates in working other pre-bill edits to ensure clean claims are sent to the payers (TES/EPIC/CM) to confirm all third-party claims are properly processed. Assist Section AD's, billing staff and billing Vendor on coding related questions/denials. Reviews and directs billing Vendor on proper handling of appeal and recommends adjustments to accounts as necessary. Includes review of monthly write offs that are coding related. May involve initiating re-billing or appealing to third parties and/or educating billing Vendor when applicable. In collaboration with billing Vendor, oversees documentation review for coding related charges/denials to assess reimbursement guidelines with third party regulations and provide Vendor education as well as physician education for DOM. Serves as an expert resource throughout the DOM on coding, documentation and related billing matters. Coordinate with Compliance on educational programs, if requested. Participates with and oversees 60-90 day chart review for new providers, following mandatory orientation. May be asked to assist with individual faculty counseling, to ensure physician are trained and knowledgeable with system(s) usage and with all third party billing guidelines needed. Works in collaboration with Ops Manager and Compliance to update physicians of documentation issues and educate them on opportunities for improvement. Assist to develop tools as needed to facilitate operational efficiency. May participate with oversite of profiling studies done, comparing department billing patterns to national standards; section level billing patterns to national specialty standards; physician billing patterns to their peers and shares such information with Practices. Maintains thorough and current knowledge of third party insurance policies by studying weekly and monthly professional bulletins/journals, frequent third party payer updates, and by attending professional seminars. Disseminates such information to keep staff informed of any changes in policy or reimbursement, in the interest of avoiding audit liability, and ensuring the maximum allowable revenue collection. Provides review, release of charges or coding of any professional services within Epic/TES work queue's, assigning CPT's, ICD9/10 codes, HCPCS, and/or Modifiers, as needed, providing feedback to staff and providers, if necessary. Maintains awareness of directives of government agencies and legislation as they relate to coding activities. Conforms to hospital standards of performance and conduct, including those pertaining to patient rights, so that the possible customer service and patient care may be provided Performs other related duties as required.
Any of the following is a plus: CPC, RHIA, CPC-H, CPC-P, CCS-P
Minimum (5+) years' experience in a healthcare organization or large multi-specialty physician organization preferred
Thorough knowledge of CPT-4 and ICD-9/ICD-10 coding and related payer regulations.
Previous experience with or exposure to medical records, reviewing and auditing Ambulatory services.
Excellent verbal, written and communication skills.
Ability to communicate and/or relate effectively, clearly and concisely at all levels.
Must be highly organized and detail oriented.
Strong computer skills including MS office, Internet and e-mail
Extensive knowledge of Massachusetts and Federal third party payer requirements.
Previous Epic experience a plus.
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