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Perform coding and related duties using established billing office policies in an accurate and timely manner. Primary contact with physicians, department administrators, hospital and/or clinical department administrators and their support staff and billing staff. Coordinates professional service billings for selected clinical departments. Primary Functions
CHARGE PROCESSING
* Assignment or verification of CPT, ICD-10 CM coding and modifiers based upon documentation. (Inpatient/Emergency Department abstraction, ambulatory coding and/or surgical/procedural coding) * Resolve edits for electronic charges, following established policies and procedures to insure that all data elements (claim requirements - CPT, ICD-10 CM, modifiers, provider, billing area, etc.) are applied. * Charge Entry as needed.
RECONCILIATION OF CHARGES:
* Monitor charge flow and act as a liaison with managers, department administrators and other billing personnel toassure consistent and accurate change flow. Work with clinic staff and physicians regarding missing or unclear information that is required for billing.
CLAIM DENIALS /BILLING ISSUES
* Identify, report, and resolve coding and reimbursement issues. Working with physicians, department administrators and other billing office staff, including reimbursement staff. Identify opportunities to reduce denials and enhance revenue.
PROTOCOLS
* Develop and maintain all protocols related to their assigned areas.
PROVIDER EDUCATION
* Maintain understanding all Teaching Physician and provider documentation policies. * Actively participate in new provider orientations. * Note and address trends in provider documentation that may impact coding and billing,