• Identifies and enters correct code selection from physician documentation, to include, but not be limited to: chart notes, abstracting from medical records documentation, medical diagnostic and/or interventional reports, ensuring compliant coding selections are reported.
• Enters most appropriate Reason for Visit, First Listed Primary Diagnosis, Procedure(s), Modifiers, and all Secondary Diagnosis accurately supports medical necessity and CCI edits.
• Verifies that the final diagnosis reflects the care and treatment rendered to the corresponding code entered.
• Works closely with Revenue Cycle team, clinics, physicians, departments, and contracted billing agency to resolve issues with insurance companies regarding incorrect registration information, claims processing, coding issues, and AR payments or denials.
• Responsible for accurate and timely processing/resolution of coding edits impacting submission of professional claims as well as payer rejections and/or denials.
• Identifies when a physician query is appropriate for further clarification. Recognizes when the documentation is missing or incomplete and routes appropriately. Validates Fee Schedule driven CPT code assignment and routes appropriately. Completes review and final coding when query and/or documentation is available.
• Ensure that patients are charged for all procedures. Reconciles charges against patient schedules.
• Verifies that coding guidelines are followed and ensures all elements of Evaluation & Management (E&M) level meet the Medicare guidelines for E&M level assignment.
• Informs providers of new coding conventions, changes in current coding conventions, and provides feedback on the providers’ coding practices.
• Maintains working day-to-day knowledge of electronic health record (EHR) and Practice Management (PM) system.
• Assists in evaluating the medical record for documentation consistency, adequacy, and signature requirements.
• Maintains Coding Quality Standards and Productivity Standard set by UT Health RGV.
• Identifies and documents new payer denial trends and notifies supervisor for escalated follow-up.
• Performs root cause analysis and identifies edit trends timely to minimize lag delays and maximize opportunities to improve processes.
• Communicates regularly and effectively with physicians, clinic staff, and revenue cycle staff for accurate and timely resolution of coding-related claim edits and appeals.
• Provides customer service to patients by addressing their questions, concerns or complaints.
• Responsible for posting payments and adjustments on patient accounts. Reconciles payment/adjustment batches daily.
• Runs billing, Accounts Receivable, denials, and any other Revenue Cycle reports as requested or needed.
• May assist clinics on completing their daily deposits information and ensure their deposit batches are reconciled daily.
• Assists in month end procedures and reporting.
• May assist in registering patient accounts where interfaces are not in place with UT Health partners. This includes entering demographic and insurance information, verifying insurance, entering referral information and/or prior authorization, posting charges and/or payments for clinic visits and/or hospital services.
• May assist clinics on figuring out patient responsibility based on Fee Schedule and/or assisting them in finding the correct CPT code to determine patient responsibility.
• Performs other duties as assigned.
• Associate Degree in Healthcare related field or Registered Health Information Technician certified, or
• Two (2) years of the required experience in lieu of associate degree in addition to the required experience.
Certified Professional Coder (CPC) or Certified Coding Specialist-Physician based (CCP-P) from American Health Information Management Association (AHIMA) or American Academy Professional Coders (AAPC).
Three (3) years of medical coding experience, knowledge of the entire claims billing, collections, and reimbursement processes experience in a multi-specialty practice, healthcare facility or ambulatory setting.
Needs to be able to successfully perform all required duties. Office environment; some travel and weekend work is required.
Excellent verbal and written communication skills are required. Must be very familiar with CPT4, ICD10, HCPCs codes and use of modifiers. Ability to be flexible with assignments and multi-task as needed. Ability to demonstrate problem-solving skills in dealing with billing and collections related issues.
It is the policy of The University of Texas Rio Grande Valley to promote and ensure equal employment opportunities for all individuals without regard to race, color, national origin, sex, age, religion, disability, sexual orientation, gender identity or expression, genetic information or protected veteran status. In accordance with the requirements of Title VII of the civil rights act of 1964, the title IX of the Education Amendments of 1972, Section 504 of the Rehabilitation Act of 1973, and the Americans with Disabilities Act of 1990, as amended, our University is committed to comply with all government requirements and ensures non discrimination in it’s education programs and activities, including employment.