General Summary of Position Responsibility:
Conducts retrospective audit of ambulatory and inpatient physician documentation to ensure billing accuracy and compliance. Accounts for concurrent inpatient billing accuracy and compliance for selected Divisions. Provides physician education on coding and documentation guidelines.
Essential Job Functions:
- Reviews and audits physicians’ documentation in the medical record and the level of CPT code selection to verify accuracy through a concurrent coding program
- Determines visit, procedure and diagnosis code(s) based on documentation
- Initiates corrections and resolves discrepancies.
- Confers with the physicians to communicate and educate when deficiencies in documentation and code selection are identified.
- Meets with Division Heads and Clinical Practice Directors or designees to present statistical data on audit findings, provides useful recommendations and documentation tools.
- Keeps informed on coding and documentation guidelines.
- Performs monthly reconciliation between concurrent charges sent and entered.
- Ensures that all concurrent charges and necessary information are submitted to the billing service in a timely manner.
- Resolves all questions and problems with patients, third party payers, billing coordinators and coding and billing analysts and external billing services.
- Performs job functions adhering to service principles with customer service focus of innovation, service excellence and teamwork to provide the highest quality care and service to our patients, families, co-workers and others.
Knowledge, Skills and Abilities:
- Certification in one of the following: Certified as Professional Coder (CPC), Certified Coding Specialist – Physician (CCS-P), or Certified Professional Medical Auditor (CPMA) required.
- Minimum of three years of coding experience required.
- Prior experience in Evaluation and Management Coding preferred.
- Demonstrates thorough knowledge of CPT and ICD-9 coding by passing a test.
- Demonstrates thorough knowledge of Evaluation and Management (E/M) by passing a proficiency test; required.
- Ability to use computer software (i.e.: EPIC, WORD, EXCEL and PowerPoint).
- Demonstrated knowledge and understanding of medical terminology, anatomy and physiology and coding classification systems in determining appropriate physician coding.
- Ability to communicate effectively, work independently and balance multiple priorities.