General Summary of Duties: Oversees processing of clinic
professional charges including updating of procedure and diagnosis codes in
computer files, coordinating reports and maintaining charge ticket files.
Supervision Received: Reports directly to Administrator.
Supervision Exercised: None
Performance Requirements:
Knowledge, Skills &
Abilities:
Knowledge of coding
policies and procedures, reimbursement practices. Knowledge of coding and clinic operating
policies. Skill in using computer and
calculator. Ability to examine documents
for accuracy and completeness. Ability
to prepare records in accordance with detailed instructions. Ability to work to
precise and established standards of accuracy. Ability to work effectively with
patients and co-workers. Ability to communicate clearly.
Education
High school diploma or GED certificate
Certified Professional Coder certification
Experience: Preferred two
years of experience within a Private Practice.
One year minimum experience
Certificate/License: CPC preferred.
Alternative to Minimum Qualifications: Additional appropriate education may be
substituted for one year in medical office environment.
Essential Job Functions: (This list may
not include all of the duties assigned.)
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Responsible for coding all daily
office visits and surgery procedures
Reviews daily chart notes and
codes appropriate CPT, ICD-10, and HCPCS codes
Understands and abides by billing
compliance regulations
Understands concept of unbundling
and heeds government regulations
Understands Medicare/payer groups
rules and regulations
Physician/PA documentation
training
Appends modifiers when appropriate Maintains procedure code
master file. Evaluates and develops
new entries.
Reviews reimbursement from third party payers to ensure
payment through proper use of codes
Maintains diagnosis code master files including identifying
inappropriate codes and informing appropriate medical staff.
Maintains charge ticket system including creating, updating
and printing tickets as necessary.
Gathers, audits, corrects clinic charge tickets including
checking for accurate patient demographic information and total charges by
monitoring patient’s charts to verify information.
Enter all charges into computer system, ensuring correct
daily totals.
Works with physicians to resolve coding issues.
Maintains fee schedules or Medicare, fee for
service, health maintenance organizations.
Generates electronic and all other insurance
claims attached physician notes as required.
Generates computer reports as required or
requested.
Verifies signed ABNs and appends
DME modifiers as appropriate
Assists with patient calls
related to billing
Understands patient
confidentiality laws and what signatures are required to release information
Clearly and accurately documents
all correspondence regarding an account in a timely and appropriate manner
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Responsible for accuracy and timeliness
of coding directly related to accounts receivable.
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COMPETENCIES:
To perform the job successfully, an
individual should demonstrate the following competencies:
· Problem Solving - Identifies and resolves
problems in a timely manner; Gathers and analyzes information skillfully;
Develops alternative solutions; Works well in group problem solving situations;
Uses reason even when dealing with emotional topics.
· Technical Skills - Assesses own strengths and
weaknesses; Shares expertise with others.
· Customer Service - Manages difficult or
emotional customer situations; Responds promptly to customer needs; Responds to
requests for service and assistance; Meets commitments.
· Interpersonal Skills - Focuses on solving
conflict, not blaming; Listens to others without interrupting; Keeps emotions
under control; Remains open to others' ideas and tries new things.
· Oral Communication - Speaks clearly and
persuasively in positive or negative situations; Responds well to questions;
Participates in meetings.
· Written Communication - Writes clearly and
informatively; Able to read and interpret written information.
· Teamwork - Exhibits objectivity and openness
to others' views; Gives and welcomes feedback; Contributes to building a
positive team spirit; Puts success of team above own interests; Able to build
morale and group commitments to goals and objectives; Supports everyone's
efforts to succeed.
· Change Management - Communicates changes
effectively; Builds commitment and overcomes resistance; Prepares and supports those
affected by change; Monitors transition and evaluates results.
· Leadership - Exhibits confidence in self and
others; Accepts feedback from others; Gives appropriate recognition to others.
· Quality Management - Looks for ways to
improve and promote quality; Demonstrates accuracy and thoroughness.
· Diversity - Shows respect and sensitivity for
cultural differences; Promotes a harassment-free environment.
· Ethics - Treats people with respect; Keeps
commitments; Works with integrity and ethically.
· Organizational Support - Follows policies and
procedures.
· Judgment - Includes appropriate people in
decision-making process; Makes timely decisions.
· Motivation - Sets and achieves challenging
goals; Demonstrates persistence and overcomes obstacles.
· Planning/Organizing - Prioritizes and plans
work activities; Uses time efficiently; Plans for additional resources.
· Professionalism - Approaches others in a
tactful manner; Reacts well under pressure; Treats others with respect and
consideration regardless of their status or position; Accepts responsibility
for own actions; Follows through on commitments.
· Quality - Demonstrates accuracy and
thoroughness; Looks for ways to improve and promote quality; Applies feedback
to improve performance; Monitors own work to ensure quality.
· Safety and Security - Observes safety and
security procedures; Reports potentially unsafe conditions.
· Adaptability - Adapts to changes in the work
environment; Manages competing demands; Changes approach or method to best fit
the situation; Able to deal with frequent change, delays, or unexpected events.
· Attendance/Punctuality - Is consistently at
work and on time; Ensures work responsibilities are covered when absent;
Arrives at meetings and appointments on time.
· Dependability - Follows instructions, responds
to management direction; Takes responsibility for own actions; Keeps
commitments; Commits to long hours of work when necessary to reach goals;
Completes tasks on time or notifies appropriate person with an alternate plan.
· Initiative -
Volunteers readily; Asks for and offers help when needed.
Typical Physical Demands:
Mobility:
*Must be able to walk,
stand, climb stairs, bend to the floor – Frequently
*Must be capable of sitting for prolonged periods – Continuously
*Must be able to squat, stand for prolonged periods, remain in
uncomfortable positions for long
periods, crawl, kneel,
twist, and reach in order to access files or objects – Frequently
Speech:
*Must have the ability
to speak clearly and make self-understood in face to face
AND phone interactions,
as well as articulate with extreme accuracy and precision to interact with
employees, patients,
physicians, and others – Continuously
Strength:
*Must be able to push/pull and lift/move object up to 25 pounds –
Occasionally
Manual Dexterity:
*Must be capable to using hands for moderately difficult
manipulation such as stapling, typing, filing,
writing, using copiers,
calculators, fax machine, phones, opening/closing/locking/unlocking
doors/drawers/cabinets –
Continuously
*Must be able to use hands and arms for simple grasping, pushing,
pulling such as carrying file folders,
x-ray jackets, packages
and boxes – Frequently
*Must be able to use hands for difficult manipulative tasks like
inserting tapes into credit card
terminals, changing
ribbons/tapes on printers, etc. - Occasionally
Coordination:
*Must have the ability to perform tasks requiring actions of
muscles and groups of muscles –
Continuously
Visual Discrimination:
*Must have visual insight to allow for overseeing entrance/exit
doors, observing people in lobby area,
reading charts and
documents - Continuously
Hearing:
*Must be capable of hearing normal sounds and voices with some
background noise to answer phones,
carry on conversations
and listen. – Continuously
Concentration:
*Must be able of concentrating on minimal to fine detail with
little to constant interruptions, such as
answering phones, typing,
filing, and assisting patients/visitors and scheduling. – Continuously
Attention Span:
*Must have the ability to attend to tasks for varying lengths of
time ranging from less than 10 minutes
to more than 60 minutes
at a time such as filing, typing, scheduling, etc. – Frequently
Conceptualization:
*Must be able to understand and relate to specific ideas and
capable of understanding concepts and
reasons behind those
ideas; this may include understanding privacy issues, completion of
registration
information, scheduling
of procedures, etc. - Frequently
Memory:
*Must be able to
remember verbal and written tasks for varying length of time ranging from a few
hours to several days,
such as phone messages, scheduling details, patients appointments and test
results. – Frequently
*Must be able to remember verbal and written tasks for lengths of
time ranging from several days to
several months. -
Occasionally
Environmental Conditions:
*Exposure to blood,
body tissues or other potentially infectious materials – Frequently
*Exposure to seasonal conditions in outside weather, including
humidity or temperature – Occasionally
*Exposure to toxins or poisonous substances, hazardous material
such as chemicals or bodily injuries
and/or loud or unpleasant
noise – Occasionally
*Exposure to communicable diseases, toxic substances, ionizing
radiation, medicinal preparations and
other conditions common
to the clinic environment - Frequently
Equipment Utilized: Common electric
switches, writing instruments, and equipment, phones, and common office
equipment. Medical devices may include
scalpels, syringes, needles, etc.
Responsibility in an emergency: All employees are expected to respond to
emergency situations involving the safety of patients, other employees and our
physical office areas.