Under direct supervision of the Billing Manager, this position reviews and resolves coding issues related to billing; researches complex coding issues and participates in process improvements related to coding and EM management. This position may also provide education to providers and staff on correct documentation, coding, and billing of visits and may performs audits of medical claims for compliance with federal coding regulation and guidelines.
Every Adelante employee will strive to maximize their performance and contribution to Adelante Healthcare and the community we serve every day. Employees are expected work in a manner that demonstrates a commitment to quality, patient safety, employee engagement, innovation, and the highest standards of personal integrity, professionalism and competence.
OUR CORE VALUES
ESSENTIAL SKILLS AND EXPERIENCE
- Associate’s degree preferred
- High school diploma or GED from an accredited institution
- Coding certification through an accredited organization, including Certified Coding Specialist (CCS) through AHIMA or Certified Professional Coder (CPC) AAPC required
- Detailed knowledge of medical coding systems, procedures, and documentation requirements
- Five (5) years of coding experience with a focus on E/M Coding and OBGYN preferred
- Highly effective written and verbal communication skills
- Ability to provide guidance and training to professional and technical staff in area of expertise
- Ability to analyze and solve problems
- Knowledge of legal, regulatory, and policy compliance issues related to medical coding and billing procedures and documentation
- Knowledge of current and developing issues and trends in medical coding procedures requirements
- Ability to adapt and modify medical billing procedures, protocol, and data management systems to meet specific operating requirements
The qualifications listed above are intended to represent the minimum skills and experience levels associated with performing the duties and responsibilities contained in this job description. The qualifications should not be viewed as expressing absolute employment or promotional standards, but as general guidelines that should be considered along with other job related selection or promotional criteria.
- Ensuring that charges are being captured, documented, and billed in accordance with policies and procedures as well as payer regulations and CPT/ICD-10 guidelines
- Review pending charges for submission to ensure accuracy of the billing, make approved changes where necessary, or return to the provider to correct the claim prior to billing to the plans
- Review denied claims for coding accuracy, make corrections as necessary and coordinate appeals/resubmission of corrected claims
- Proactively identify areas of opportunity to improve the charge capture processes to meet compliance regulations and maximize revenue
- Research, analyze, and respond to inquiries regarding coding, documentation, denials, and billing
- Remain current with industry changes and educate Adelante staff on such changes
- May assist in creation of training materials, periodic education and training sessions with providers and coding staff on medical coding and documentation requirements as needed
- Interacts with providers and management to review and/or implement codes and to update charge documents
Additional Duties and Responsibilities
- Other duties as request or assigned
All employees are responsible for promoting and participating in interdisciplinary communication and collaboration to enhance the delivery of quality across the health care system. Employees should maintain an environment which supports and engages patients and co-workers in a caring team based model to promote wellness and improve health outcomes.
Adherence to Compliance and Code of Conduct
All employees are required to comply with Adelante Healthcare’s written standards, including its Compliance Program and Standards of Conduct, policies and procedures and reporting of any conduct that potentially violates Adelante’s legal or compliance requirements. Such compliance will be an element considered as part of the regular performance evaluation.
PHYSICAL DEMANDS AND WORK ENVIRONMENT
The physical demands and work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Physical demands: While performing the duties of this job, the employee may be required to sit for long periods of time, is required to stand, walk, use hands to handle or feel objects, tools or controls; reach with hands and arms; climb steps/stairs; balance; stoop, kneel, crouch or crawl; talk or hear; smell; manage stress as it relates to essential job functions. The employee must frequently lift and/or move up to 25 pounds without assistance, and may occasionally be required to lift or move up to 50 pounds with assistance. Specific vision abilities
required by the job include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus.
Work environment: While performing the duties of this job, the employee is exposed to weather conditions prevalent at the time when traveling to various clinic
sites. The noise level in the work environment is usually moderate. The employee may be subject to health hazards (contagious diseases, blood borne pathogens, etc.) when working in the clinic area.
In any organization or job, changes take place over time. Although an effort will be made to keep job-related information current, this is not an all-inclusive list of job responsibilities. Adelante Healthcare, Inc. reserves the right to revise or change job duties and responsibilities as the business need arises. In compliance with EEOC 29 CFR part 1630, if the essential functions of this position cannot be performed in a satisfactory manner by the employee, further accommodations shall be made if it does not constitute undue hardships upon this organization.