The 4D Healthware Medical Billing Coder is to review clinical statements and assign standard codes using CPT, ICD-10-CM, and HCPCS Level II classification systems. Medical classification, or medical coding is the process of translating medical reports into a code used within the healthcare industry. The use of medical codes helps summarize medical services and reports. These medical code sets help medical coders document the condition of a patient and describe the healthcare procedures performed on a patient in response to their condition.
Medical billing is the process of submitting and following up on claims with health insurance companies in order to receive payment for services rendered by a healthcare provider.
- Performs accurate data entry by utilizing computerized abstracting system.
- Meets production and quality standards for number of records coded and abstracted.
- Continually assesses and evaluates clinical edit compliance with CMS and industry standards
- Reads and analyzes Medicare policy including final rulings, daily transmittals, bulletins, policy manual updates and more to begin the cycle of product development/maintenance
- Analyzes, reviews, studies and verifies data as it becomes available from government and other policy agencies. This can be a 1,200 page Medicare rule or revisiting a physician fee schedule (data file) that has been reposted
- Contacts various government entities to clarify new and existing policy
- Develops formal clinical edit criteria within system payment rules and develops payment policy rules
- Acts as a clinical liaison and subject matter expert with internal staff and clients
- Engages existing clients to identify specific functionality requirements
- Suggests and presents claim edits to clients for selection
- Coordinates with developers, QA, and client service team members to ensure that clinical edits are implemented accurately and timely
- Writes requirements
- Develops test claims for UAT and QA
- Develops and maintains a high level of proficiency in the Company’s products (software, data) and services (advisory, analytic, training/education), including commercial contracting features as related to the specific area(s) assigned
- Develops and delivers internal and external educational presentations related to Medicare/Medicaid reimbursement or commercial contracting features
Education and Experience Required
- Extensive background of ICD-10 and CPT coding principles
- Extensive knowledge of medical claim editing (NCCI, etc.)
- Knowledge of industry standard payment rules and methods
- Recognized prior expertise in claims processing, payment policy, or contracting
- AHIMA, AAPC or other nationally recognized coding certification [Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) certification], preferred
- Excellent Communication Skills
- Self-motivated with the ability to work independently and in a team environment
- Critical (analytic) thinking, looking into logic-based details while problem-solving for the overall big picture
- Professional poise: ability to credibly interact with and educate various internal and external groups and individuals (colleagues, clients, industry groups), about effective coding and billing.
Date Posted: 12 Jun 2019