Job Description
Job Summary - will evaluate a wide range of patient medical records and ensure accuracy of coding and proper billing of the medical record in accordance with medical and legal standards.Maintains an in-depth knowledge of guidelines, practices, standards, and demonstrates in-depth knowledge of SOP policies and procedures.Performs functions required in order to apply payments to accounts in an efficient and accurate manner following departmental and payor policy and procedures.Works proactively, assisting patients/ families with account inquiries and providing a friendly and knowledgeable reception for our patients.ESSENTIAL DUTIES AND RESPONSIBILITIES include the following.Other duties may be assigned.Certified Coding Read and interpret medical records to identify and code billable services and applicable diagnosis codes in EMR for charge review, specifically but not limited to, all new providers, for a minimum of 30-60 days or until determined otherwise.Assure timely and accurate submission of claims to maintain the highest quality of service and timely payment Randomly analyze/audit medical records to identify documentation deficiencies and ensuring coding is accurate and sequenced correctly according to CPT and ICD10 guidelines, verifying documentation supports diagnoses, procedures, and treatment results Research compliance issues with regulatory guidelines and applicable laws Researches, analyzes, recommends, and corrects discrepancies and prevent future coding errors Communicate with clinical staff and providers regarding documentation that is insufficient or unclear Review coding denials and submit corrected claims as needed once approved by billing provider Appropriately escalate any coding questions or concerns to the office manager, managing partner or billing physician Analyzing coded data for reimbursement purposes, identifying trends, and contributing to data-driven decision-making.Works with physicians and other healthcare providers to clarify coding issues and ensure accuracy.Other Revenue Cycle duties Research and resolve Medicaid, OHP and commercial denials and no response to claims Compose and submit claim appeals as required by payor policies Perform data entry to record payments and insurance explanation of benefits/payments Review guarantor accounts for coverage and demographic issues that may cause denials Create estimates for patients as requested and required Conduct collections calls and balance reminders as requested Assure timely and accurate submission of claims and follow up activities performed to maintain timely payment and data integrity Confirms active insurance eligibility and register new insurance Work closely with cross-functional team members to resolve duplicate accounts, insurance coverage and benefit questions, and any other issues Consistently conduct all activities upholding the highest standards of professionalism and confidentiality.Complies with all applicable laws, regulations, policies and procedures, supporting SOP by acting in an ethical and appropriate manner Demonstrate exceptional customer service by effectively utilizing communication skills in a manner that supports SOP's clinic vision, values and mission Preforms onsite administrative duties Job Type:Full-time Pay:$28.00 - $29.00 per hour Expected hours:40 per week Benefits:401(k) Dental insurance Flexible schedule Flexible spending account Health insurance Life insurance Paid time off Vision insurance License/Certification:Medical Coding Certification (Required) Ability to Commute:Medford, OR 97504 (Required) Work Location:In person.