The Medical Coder is a key associate at Hope Network whose primary responsibilities include: Provides proper coding for services billed at Hope Network. This position needs a working knowledge and experience on coding for professional services with emphasis on evaluation and management codes for many different places of service (POS) This position is also responsible for the accuracy of CPT, HCPCS, ICD-10 codes, modifiers and editing of charges before billing and/or after a rejection from the payer.
ESSENTIAL FUNCTIONS AND RESPONSIBILITIES:
This is not intended to be an exhaustive listing of job functions. This job description is in no way states or implies that these are the only duties to be performed by this employee. The employee is required to follow any other instructions and to perform any other duties as assigned.
1. Regular and predictable attendance is an essential requirement of this position.
2. Coding of services provided by professional staff with different disciplines and an emphasis on evaluation and management coding.
3. Insuring all applicable diagnostic codes are used and follow ICD-10 coding guidelines
4. Follow up on all relevent coding rejections from payers as needed.
5. Utilize specific knowledge regarding coding, billing and reimbursement guidelines to expedite payment for services.
6. Provide on-site assistance to staff from all locations with coding issues.
7. Provide assistans as needed in the review of overpayments.
8. Utilize systems and procedures to organize the billing office for maximum efficiencies.
9. Assure that computer system procedures including, but not limited to, end of day reconciliations and report printing are completed.
10. Helps billers with coding issues on all outstanding accounts over 60 days old for collectability.
11. Analyze and review reports for CPT codes, dx codes and modifier issues.
12. Make coding changes relevant to incorrect charges.
13. Maintains a working knowledge of and follows all CPT, HCPCS, and ICD-10 rules and guidelines.
14. Compile statistical information to be included in reports for Revenue Management Director.
15. Attend meetings with Business Directors on statistical findings.
16. Completes all other designated projects relevant to position description.
Educational / Talent Requirements:
1. Associates degree in a related field; Business, Finance or Health Administration or the equivalent of applicable work experience.
2. Current Coding Certification for professional services from a nationally recognized organization.
3. Must understand the differences between CPT, HCPCS and ICD-10
4. Demonstrated ability to communicate in both written and verbal format to meet position responsibilities.
5. Demonstrated ability to use word processing, spreadsheet and computerized billing programs including Word/Excel.
6. Ability to plan, organize and prioritize work on a daily basis.
7. Demonstrated organizational skills, attention to detail.
Work Experience Requirements:
1. 2 – 4 years prior work experience in coding for professional services. Experience in evaluation and management coding a must.
2. Experience in data processing and total business office procedures.
3. Demonstrated knowledge of CPC, HCPCS and ICD-10 rules and guidelines.
4. Ability to interact effectively with individuals, employees, referral sources, vendors and other designated individuals.
5. Ability to travel to other Hope Network sites when needed and requested; valid Michigan driver’s license with acceptable driving record.
6. Ability to articulate and actively support the mission of the corporation to various audiences.