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Clinic Coder & Reimbursement Specialist

Company: Aspen Valley Hospital
Location: Aspen
Posted on: December 4, 2018

Job Description:

Responsible for coding and abstracting medical records in the clinics to facilitate timely billing and maintain accurate acuity and provider statistics following AVH and industry standard coding guidelines. Enters codes for diagnosis (ICD10-CM), procedures (CPT/HCPCS), and other professional fees/services in accordance with and in compliance with industry standards and coding guidelines. Utilizes 3M encoder software as well as eClinicalWorks software. Maintains currency with coding protocols, regulations and changes (both as they are updated and annually at a minimum). Monitors unbilled accounts (working from the DNFB and bill hold reports) for outliers and resolves billing issues relative to coding for the billing office. Understands and utilizes coding references appropriately to clarify/interpret coding guidelines for accurate code assignment. Works with staff (clinical and provider) to resolve any issues (billing, documentation, queries). Alerts staff to discrepancies and/or incorrect documentation (clinic notes, orders, notes, etc). Reviews all medical record documentation for accuracy, including but not limited to: billing review to assess appropriate capturing of charges based on medical record documentation, review of dictated (or electronically produced) and hand-written entries in the medical record to asses for compliance with regulatory and accrediting agencies. Coordinates payer audits in conjunction with the billing office and assists with medical records, coding and charge capture/reconciliation as necessary. Familiar with: Medicare: CoP, Claims Processing Manual(s), LCD/NCD, ICD10-CM CPT/HCPC Coding Duties - Essential Job Duties Verifies insurance and demographic information, completing and documenting ABNs as appropriate. Reviews registration to ensure that information is 100% complete and accurate. Ensures that all compliance requirements have been met, and the registration is properly created and/or updated for anticipated billing. Codes and abstracts patient encounters with accuracy and timeliness Enters codes for diagnosis (ICD10-CM), procedures (CPT/HCPCS), and other professional fees/services Works with staff (clinical and provider) to resolve any issues (billing, documentation, queries). Alerts staff to discrepancies and/or incorrect documentation (clinic notes, orders, notes, etc). Reviews all medical record documentation for accuracy. Trends and reports results of charge capture reviews for each clinic. Coordinates payer audits in conjunction with the billing office and assists with medical records, coding and charge capture/reconciliation as necessary. Reviews patient account charges in comparison with documentation to determine whether charges are substantiated, within the bill/claim lock processing time requirements. Is thoroughly versed in Hospital and applicable HIPAA regulations and is especially sensitive to, and mindful of, patient confidentiality in all scenarios. Conforms to all regulations without exception. Communicates and coordinates information in a knowledgeable and courteous manner with staff, patients, and families. Answers telephone calls promptly and responds to requests and messages in a timely manner. Takes accurate messages, relays/forwards messages to appropriate personnel, and refers callers to appropriate personnel as needed. Patient Safety & Confidentiality Adheres to all accepted patient safety standards Follows all security, confidentiality, privacy policies as well as all industry specific rules and regulations. Unit Specific Duties and Responsibilities/Day to Day Operations Meets 95% accuracy standard for coding/abstracting duties. Prioritizes work load. Meets productivity standards, as industry benchmarks recognize as: > 50 charts/hr in clinics, Hospital work (4-6 records/hr) Participates and contributes in Department meetings Other duties as assigned/requested. EDUCATION/EXPERIENCE REQUIREMENTS High school diploma/GED equivalent Knowledge of medical terminology required 2 years' experience in billing, claims or other payer relations in a hospital setting preferred CPC, CCS or CCS-P preferred KNOWLEDGE AND SKILL REQUIREMENTS Ability to concentrate and show attention to detail Relatively high degree of analytical abilities Strong interpersonal skills required Ability to work independently Computer skill experience required Medical terminology required Familiarity with: CMS CoP, LCD/NCD Claims Processing Manual(s), ICD10-CM CPT/HCPCS LANGUAGE SKILLS Ability to read and communicate effectively in English Spanish preferred

Keywords: Aspen Valley Hospital, Aspen , Clinic Coder & Reimbursement Specialist, Healthcare , Aspen, Colorado

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