Responsible for all aspects of coding, quality assurance and compliance of legal requirements. Works closely with departmental management and coordinates with Clinical Practice Association, Office of Billing Quality Assurance to include review of documentation. Serves as departmental expert on coding questions. Exercises independent judgment and decision making on a regular basis.
The primary duties and responsibilities of the job:
Procedural Knowledge:Responsible for all aspects of coding, quality assurance and compliance of legal requirements. Works closely with Office of Billing Quality Assurance to include review of documentation. Serves as departmental expert on coding questions. Exercises independent judgment and decision making on a regular basis. Holds bills and seeks corrective action for services not meeting documentation requirements in accordance with CPA policies. Researches and answers billing and documentation questions or problems submitted by faculty, department, billing staff, and others to ensure compliance with specific payer regulations and CPA policies and procedures. Supports department compliance efforts through participation in department training and education programs relative to specific product lines in accordance with established policies. Conducts feedback/training sessions for physicians to present the results of medical record documentation as warranted. Gathers and verifies all information required to produce a clean claim including special billing procedures that may be defined by a payer or contract. Maintains a system of billing accuracy through encounter verification i.e., clinic schedules, encounter forms, I/P consults, medical records. May review and resolve work queues edits daily. May obtain correct NPI number and all needed information for Referring Doc Dictionary. May act as a back up to Charge Entry when needed. Pro Fee Tracking Database- May fill out missing information form and forward to the appropriate contact person. Periodic review with departmental staff of encounter forms or coding forms to ensure they are current.
Technical Knowledge: Comprehensive knowledge and compliance of HIPAA rules and regulations in the dissemination of patient Protected Health Information (PHI). Working knowledge of JHU/ PBS Billing Applications. Utilize online resources to facilitate efficient claims processing. Capable of advance problem solving in medical billing and coding.
HS /GED required. Medical Terminology, Anatomy and Physiology courses required or demonstrated appropriate knowledge required. CPC or pre-approved specialty certification required. Two (2) years related CPT and ICD10 coding experience required. Recent experience with Medicare regulations required. Additional education beyond minimum experience qualifications may substitute for required experience to the extent permitted by the JHU equivalency formula.
JHU Equivalency Formula: 30 undergraduate degree credits or 18 graduate degree credits = 1 year of experience. For jobs where equivalency is permitted, up to two years of non-related college coursework may be applied towards the total minimum education/experience required for the respective job.
Associates Degree preferred. Thorough understanding of third party payer issues preferred.
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