Responsible for reviewing, auditing and the education of all coding and compliance processes, as they relate to UM Referral entry, and Operative Report Review for both internal and external physician payment. Also responsible for HCC audit compliance.
Education and/or Experience: High school diploma or general education degree required. Knowledge of medical terminology required. Two (2) years’ experience in the coding field.
Certificates, Licenses, and Registrations: Medical Coding certificate required. CPC.
Essential Functions: Essential functions are those tasks, duties and responsibilities that comprise the means of accomplishing the job’s purpose and objectives. Essential functions are critical or fundamental to the performance of the job. They are the major functions for which the person in the job is held accountable. Note: (other duties may be assigned, deleted or changed at any time, at the discretion of management, formally, or informally, either verbally or in writing).
1. Perform and complete audits on UM physician referrals for accurate CPT and ICD9 coding.
2. Read and analyze medical records to help identify all diagnoses, operations and procedures relevant to the referral.
3. Clarify inconsistent, doubtful or non-specific information in a medical record by consulting with the responsible medical practitioner.
4. Utilize appropriate ICD9 codes consistent with episode of care, focusing on the identifying appropriate HCC conditions.
5. Performs HCC audits to enhance coding and collection of quality health data.
6. Participate in the clinic’s Coding & Compliance Committee.
7. Assist Utilization Director in identifying and drafting Policies & Procedures related to Compliance and correct coding guidelines specific to the UM Department.
8. Assist with the education of UM Staff with regards to CPT and ICD9 coding.
9. Assist in updates to the internal support files for CPT and Diagnosis codes and all related paper documents by communicating with Director of RMC Business Office.
10. Verify patient benefits and eligibility prior to authorizing services.
11. Update insurance records as necessary.
12. Update authorizations on system to ensure timely turnaround and compliance with health plan requirements.