This position is a key component to AR days. Responsible for Coding all outpatient services within established benchmarks for the Medical Practice Network. Assignment of accurate diagnosis and procedure codes, charge capture and review. Works closely with front and back end revenue cycle departments to ensure accurate claim submission. Must maintain coding credentials and have a working knowledge ICD, CPT, & HCPCS along with payer edits. Key player in denial management team.
JOB RESPONSIBILTIES:
Practice Management SPECIALIST – OUTPATIENT SERVICES:
• Accurate assignment of both diagnosis and procedure codes along with any applicable modifiers. Timeliness: Within 7-10 days after day of visit (depending on physician completion).
• Works with CBO Manager to resolve any issues needed to be addressed at practice level.
• Enlists the assistance of the 3M encoder paying attention to OCE, 3M and MU edits; clearing all for a clean bill.
• Enlists in the assistance of Vitalware for CPT, APC, LCD/NCD reference materials as appropriate.
• Acts as facility resource person for outpatient coding/sequencing and grouping.
• Carry knowledge of medical coding guidelines and regulations including compliance and reimbursement
DOCUMENATION MANAGEMENT
• Communicate with clinicians via documentation queries when documentation is conflicting or missing.
• Provide clinician educational feedback on appropriate documentation practices; per federal, state and coding regulations. In the form of Physician Queries, Educational Brochures, Attendance at Medical Staff meetings, and/or one on one sessions.
• Work with Management on Record Completion to ensure missing documentation is obtained.
• Work with Management to ensure timeliness of provider documentation and report any delinquent data.
CHARGE MANAGEMENT
• Performs verification of charges on all outpatient accounts. In some circumstances, will be responsible for actual charge entry and crediting charges.
• Perform reimbursement audits to ensure proper payment from insurance.
• Assist in Patient Estimation requests from staff.
DENIAL MANAGEMENT:
• Maintains a full understanding of ICD, CPT, HCPCS, keeping updated on all changes.
• Daily work with the Business office and third party billing staff to work through denials and claim rejections and edits.
• Works with physicians to obtain appropriate documentation as needed.
• Educates physicians on the appropriateness of documentation to meet compliance regulations.
QUALITY
• All required data elements must be accurately abstracted and/or reported.
• All diagnosis and procedures are identified and coded accurately.
• All codes are accurate according to 3rd party specs and other coding guidelines.
• Ensure clinician documentation reflects all codes assigned.
MEDENT:
• Performs all required MEDENT functions as efficiently as possible and according to procedure. Utilizes all applicable applications as necessary.
• Runs the delinquent data reports for unsigned charts to ensure all applicable accounts have been received, coded and billed in a timely manner. Timeliness: On a weekly basis.
• Updates and monitors on a daily basis, the outpatient coding /deficiency/delinquent log.
• Understand the flow between the various EMR systems within the Medical Practice Network and Hospital.
• Identify and troubleshoot system issues
• Take part in system testing as appropriate.
COMMUNICATIONS:
• Maintains rapport with all medical staff.
• Interacts continuously with other departments, i.e., Business Office, RI, all offices within the Medical Practice Network to ensure all reports are complete, coded, abstracted, and billed accurately.
• Exhibits exceptional customer service attributes consistently in all interpersonal relationships.
• Treats all customers in a caring, helpful and respectful manner, always displaying a willingness to assist.
• Communicate effectively at all levels, internal and externally.
• Displays adaptability in order to meet changing conditions in problem situations.
• Treats all customers in a caring, helpful and respectful manner, always displaying a willingness to assist.
• Will exhibit exceptional customer service characteristics at all times, including phone contacts.
• Will be aware of and report any opportunities/instances of continuous process improvement.
• Will be aware of and abide by all corporate and department compliance policies and procedures.
• Will be aware of and abide by all HIPAA requirements when effective.
OTHER
• Provides training for new providers as well as new employees.
• Performs other duties as necessary when requested and provides coverage during vacations.
• Maintains required CE credits for accreditation status and remains atop new regulations and keeps code books current.
• Aware of and report any opportunities/instances of continuous process improvement.
• Is aware of and abides by all corporate and dept. compliance policies and procedures, especially coding.
• Abides by the AAPC Code of Ethics and is aware of and signs periodic updates.
• Other duties as assigned by the CBO Manager
