Reviews and analyzes medical billing and coding for processing. Accurately abstracts data and codes ambulatory surgery center procedures for reimbursement using ICD-10, CPT, and other applicable patient classification schemes.
- Knowledge of pertinent Federal, State, and local laws, codes, and regulations related to patient billing and collection.
- Demonstrated ability to apply all coding rules and use of CPT and ICD codes and appropriate use of modifiers.
Primary Duties and Responsibilities
- Reviews medical record documentation for accuracy and to identify diagnoses and procedures. Abstracts and ensures accuracy of diagnosis, procedure, patient demographics, and other required data elements. Assigns correct diagnostic and procedural codes using standard guidelines and automated encoding software maintaining departmental accuracy standards.
- Contacts physician when conflicting information appears in the medical record. Reports missing or incomplete documentation to management.
- Performs timely and accurate charge entry into billing system .
- Reconciles charges and performs batch processing. Submits claims and works rejects for claims submission. Resubmits/refiles and appeals rejected claims, as necessary.
- High school graduation or equivalent. Associate’s or Bachelor’s degree preferred.
- Medical Coding Certification with successful completion of medical terminology, anatomy, physiology, and coding courses in ICD-10-CM and CPT-4 preferred.
- Certified Professional Coder (CPC) preferred but not required.