General Summary

Under direct supervision ensures physician billing charges are received from hospital, ambulatory surgical center, and off site practices on a timely basis. Ensures that charges are coded appropriately from the medical record by assigning the highest level of specificity for medical diagnoses codes and assigning the appropriate CPT. Responsible for reviewing and/or entering the information into the billing system accurately and timely.

Principal Responsibilities and Tasks

The following statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all job duties performed by personnel so classified.

1. Obtains, reviews, reconciles and logs charge batches from hospital, ambulatory surgical center, and off site practices.
2. Review provider medical documentation in EHR and charge tickets for accuracy. Includes dates of service, procedures, and levels of care, locations, diagnosis (for medical necessity), patient identification and provider signature. Return any incomplete charge tickets to the provider for correction.
3. Analyze and interprets patient medical records within an area of medical/clinical specialty in order to determine amount and nature of billable services.
4. Utilizes advanced, specialized knowledge of diagnoses and procedures coding to assign sequence appropriate diagnostic/procedures billing codes to operative and other physician medical record documentation in compliance with established standards and guidelines and third party payor requirements.
5. Interacts with providers and other medical professionals regarding billing and documentation policies, procedures, and regulations. Obtains clarification of conflicting ambiguous or non-specific documentation. Acts a liaison between the clinical and billing departments. Answers questions from billing in a timely manner
6. Meets established productivity and proficiency standards.
7. Monitors billing for optimal reimbursement while adhering to all insurer regulations regarding the prohibition of unbundling and other questionable practices.
8. Responsible for working and resolution of appropriate work queues in the billing system.
9. Assists in working denial work queue to resolution, with the primary focus on ICD-10 and CPT coding.
10. Utilizes appropriate customer relation skills to ensure all customers are treated with respect and dignity and that the confidentiality of their data is upheld.
11. Attends coding seminars, hospital and department meetings as required or assigned. Actively participates in hospital educational in services.