Required Education and Experience:
High School diploma or equivalent and a minimum of 5 years
coding/healthcare reimbursement experience.Certification by American Academy of
Professional Coders (CPC) for a minimum of 5 years or equivalent organization
and CRC (Certified Risk Coder) certification. Must have advanced knowledge in
medical terminology and anatomy. Must have advanced knowledge of insurance
reimbursement, principles and practice. Must have knowledge of computer and
Develop educational material and conduct classes for coding and
reimbursement education. Provides information based on CPT, ICD-10, HCPCS and
RAF scores. Along with federal and local healthcare regulation reimbursement
policies and procedures.
Conduct Classroom and
Individual training/education of coding, reimbursement & payer guidelines
to all providers and staff.
aberrances and atypical billing. Identify potential risks to the organization
and ensure compliance to policies.
Review all reimbursement
tools for coding/policy additions, revisions and deletions. Items must be
communicated in a timely manner to all pertinent providers and staff.
Assist with per specialty
practice assessments. Identify any potential risk. Ensure compliance to
policies and procedures. Review pertinent payer regulations and coding
guidelines. Review all applicable templates and current reimbursement tools
pertinent to the specialty. Analyze denied services and adherence to federal
and local guidelines.
Must remain current with
CMS/Federal guidelines (i.e., federal register, transmittals and LCD’s). Review
all updates published on a daily basis and distribute information to providers
Demonstrates a contribution
to the department’s operation and goals/targets for the year. Maintains monthly
log of activity. Prioritizes workload maintains control over
Demonstrates ability to use
coding software programs, IDX system, LCD and local hospital resources to conduct
research. Ability to use IDX reports for retrospective or concurrent reviews,
as assigned. Pursues medical records needed from outside resources (i.e. SNF,
Adheres to guidelines set by
the clinic’s Compliance Program and Audit policy and procedures