Responsible for diagnosis and CPT coding within the various department billing offices. Will review or code charges for diagnosis and CPT for entry into the JHM and JHU/ PBS billing applications. This can be accomplished through an interface or manual charge entry for services performed at JHM practice sites. Must be able to exercise independent judgment.
Principal Duties and Responsibilities:
*Gathers and verifies all information required to produce a clean claim including special billing procedures that may be defined by a payer or contract.
*Bundle appropriately for CPT and payer guidelines.
*Maintains a system of billing accuracy through encounter verification i.e., clinic schedules, encounter forms, I/P consults, medical records.
*Verify location of codes for appropriateness.
*Verify provider type i.e., level 1, 2, etc according to visit and procedure.
*Responsible for maintaining a system of billing accuracy through encounter verification i.e., clinic schedules, encounter forms, I/P consults and medical records.
*Follows payer guidelines.
*Follows limiting coverage guidelines for diagnosis coding.
*Carries coding out to fourth or fifth digit as appropriate.
*Uses E and V codes according to payer guidelines for supplemental information.
*Follows ICD-9 codes to ensure diagnosis codes are appropriate for each specialty.
*May review and resolve TES Edits daily.
*May obtain correct NPI number and all needed information for Referring Doc Dictionary.
*May pick up and deliver charge vouchers to various departments.
*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.
*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.
Professional & Personal Development:
*Participate in on-going educational activities.
*Assist in the training of staff.
*Keep current of industry changes by reading assigned material on work related topics.
*Complete three days of training annually.
Department Specific Responsibilities:
Service Excellence: *Must adhere to Service Excellence Standards.
oContinuous Performance Improvement
Supervision of Others:
*High School Diploma or GED required.
*Courses in Medical Terminology, Anatomy, and Physiology, or demonstrated appropriate knowledge preferred.
*Two years related college level courses equal to an Associate of Arts Degree preferred.
*CCS-H or CPC Certification preferred.
Additional job related experience beyond minimum experience qualifications may substitute for formal education requirement to extent permitted by JHU equivalency formula.
*One year related experience required.
*IDX and Microsoft experience preferred.
*Ability to code from medical record documentation or narrative diagnosis or procedure description preferred.
*Understanding of third party payer issues preferred.
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