Part-Time Vinings location. Performs PMCC physician office chart audits, as assigned, utilizing advanced knowledge of CPT, HCPCS and ICD-9 coding to ensure that documentation by the physicians and mid-level providers conforms to legal and procedural requirements for the level of E&M and procedural codes selected. Confirms that the appropriate diagnostic and procedural codes documented in patient medical records were reported to the insurance company for the purpose of claims processing. Interacts with physicians, mid-levels and other patient care providers regarding billing and documentation policies, procedures and regulations. Obtains clarification of conflicting, ambiguous, or non-specific documentation. Monitors billing performances to ensure optimal reimbursement while adhering to regulations prohibiting unbundling and other questionable billing practices. Performs audits and analyses of payer denials; provides feedback to physicians and other patient care providers regarding improved documentation practices to avoid future claims denials. Interacts with management, office and administrative staff regarding implementation of new codes and/or revision of current codes. Provides CBO with answers to coding problems to ensure appropriate reimbursement, as needed. Ensures compliance with Federal and State regulations. Adheres to HIPAA guidelines by maintaining confidentiality of all findings and materials reviewed. High School Diploma or equivalent with at least 5 years medical coding and auditing experience in physician office setting with a heavy emphasis on E&M coding. Associate's degree preferred. Certified Procedural Coder or the equivalent required: CPC or CCS-P. Computer literacy required; NextGen and or EMR experience strongly preferred. Might also be available as a PRN opportunity |
