General Description: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.
Duties and Responsibilities:
* 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 TES 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.
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: * Review Coding updates / changes at Department and Division Faculty meetings. * Attend CPA Compliance Meetings when necessary. * Review compliance audit results with their providers. * Submit TAP user configure changes for their providers. * Monitor Provider billing back logs. * Submit Fee schedule updates to the IS team * Monitor and fix Interface fatal and non-fatal edits. * Responsible for New Provider Coding and Tap Training
High School Diploma or GED required. Associates Degree preferred. Two years related experience required. Additional education may substitute for required experience, to the extent permitted by the JHU equivalency formula.
Recent experience with Medicare regulations required. Medical Terminology, Anatomy and Physiology courses required or demonstrated appropriate knowledge required. CPC or pre-approved specialty certification required.
Johns Hopkins University remains committed to its founding principle, that education for all students should be grounded in exploration and discovery. Hopkins students are challenged not just to learn but also to advance learning itself. Critical thinking, problem solving, creativity, and entrepreneurship are all encouraged and nourished in this unique educational environment. After more than 130... years, Johns Hopkins remains a world leader in both teaching and research. Faculty members and their research colleagues at the university's Applied Physics Laboratory have each year since 1979 won Johns Hopkins more federal research and development funding than any other university. The university has nine academic divisions and campuses throughout the Baltimore-Washington area. The Krieger School of Arts and Sciences, the Whiting School of Engineering, the School of Education and the Carey Business School are based at the Homewood campus in northern Baltimore. The schools of Medicine, Public Health, and Nursing share a campus in east Baltimore with The Johns Hopkins Hospital. The Peabody Institute, a leading professional school of music, is located on Mount Vernon Place in downtown Baltimore. The Paul H. Nitze School of Advanced International Studies is located in Washington's Dupont Circle area.