|Employer:||Eastern Virginia Medical School
|Required Experience:||3 to 4 years
|Location:|| Norfolk 23501, VA, US
|This position is responsible for reviewing and assigning appropriate ICD-9, ICD-10 and CPT codes to incoming work (services rendered by providers.), thereby maximizing reimbursement received from third party payors. This position is responsible for assisting with physician/staff education based upon EVMS Medical Group Compliance Guidelines, HCFA Teaching Physician Guidelines, coding guidelines and results of chart audits. Assist with conducting internal departmental mini-audits to ensure inpatient and outpatient medical records contain sufficient documentation to justify the frequency and type of services being billed to carriers and patients.
- Conduct monthly provider and staff coding and compliance education classes as needed/requested.
- Assist with recommendations on implementing procedures for compliance within the surgery setting.
- Assist as needed to develop Surgery compliance, coding, and billing policies and procedures based on the EVMSMG Compliance Plan and the HCFA Teaching Physician Guidelines.
- Review and “work” monthly denials and Medical Group Spread sheets
- Process/key physician charges
- Ongoing review of compliance, coding, and billing, literature and guidelines effecting academic medicine and surgery practice.
- Performs internal quality assurance charge/chart audits in a timely and consistent manner on both outpatient/inpatient services and surgical services.
- Researches and assign the appropriate CPT/ICD-10 code based on the physician’s dictation, and other medical records to ensure that the most accurate combination of codes is used for each patient.
- Audits and reviews the appropriateness of the CPT and ICD-10 coding selections, assuring that the appropriate link between the two coding procedures has occurred.
- Functions as liaison between the physicians, the data entry staff and the Medical Group Billing Office to communicate and/or educated regarding the appropriate use of the procedural and diagnostic coding process.
- Review monthly charge allowance reports to ensure utilization of appropriate fees in such a manner that reimbursement is maximized.
- Supervise the charges being entered into patient record adhering to carrier regulations.
- Each record reviewed for quality and content with special emphasis on:
- History and examination
- Procedure and diagnostic linkage
- Medical decision making
- Selected code
- Completes and follows up on missing Information from Physicians when the information provided does not support the services rendered.
- Coordinates the activity of coding and data entry to ensure their accuracy as they relate to the billing process.
- Performs other duties as assigned.
Associates degree plus 4 years’ experience working with CPT/ ICD-9 & ICD 10 coding and a comprehensive understanding of all insurance types and requirements. Current CPC certification is required and must be maintained annually. Surgery coding experience a plus.
EVMS is an equal opportunity/affirmative action employer of minorities, females, individuals with disabilities and protected veterans and is a drug and tobacco free workplace.