HospitalClinic CoderBiller

Position Summary:

CODER:

Reviews medical documentation from physicians and other healthcare providers.

Assigns diagnostic and procedure codes for inpatient outpatient symptoms diseases injuries surgeries and treatments according to official classification systems and standards.

Provides accurate and timely ICD-10 CM and CPT procedure coding and may utilize HCPCS in accordance with official coding standards regulatory coding compliance guidelines and company procedures.

Review and update medical record documentation to accurately reflect healthcare coding and substantiate appropriate service reimbursement.

Working with other departments and organizations to assure availability and quality of information used in statistical reporting for local facility management and helping identify overall healthcare trends issues and concerns.

Follow up of coding denials and regular maintenance of coding work queues.

INSURANCE APPLICATION SUPPORT:

Updates Winner Regional patient billing system with current demographic and insurance information for hospital and clinic charges.

The insurance application support is responsible for investigating and confirming valid insurance data if unable to determine from the source document. The insurance application support may also be responsible for preparing charge tickets for data entry. The insurance application support may also perform follow-up with payers where claims have been filed. Performs re filing of claims when necessary.

MEDICAL BILLER:

Manages patients accounts following guidelines for disposition of unpaid services i.e. intervening with third party payers.

Answers incoming calls from patients and third-party payers requesting information on their account

Submits and follows up on insurance claims

Attributes to include:

Knowledge of CAH & RHC coding guidelines patient account policies insurance participation/payer guidelines and individual clinic practices/standards of operation. Knowledge of insurance processing functions. Skills in verbal and written communication. Ability to work effectively with patients physicians managers directors staff and the public. Ability to work with the compliance department to achieve coding goals.

Knowledge of insurance procedures and practices Knowledge of computerized system. Skill in operating office equipment Ability to deal courteously with patients outside organizations co-workers on the telephone and in person. Ability to react calmly and effectively in conflict situations. Ability to speak clearly and concisely. Ability to establish priorities coordinate work activities and meet deadlines. Bimonthly provider chart audits and provider feedback.

Knowledge of medical billing practices insurance procedures and practices. Tact and courtesy in dealing with all customers. Able to work with limited supervision. Must have good knowledge of claim processing. Must be able to pay attention to details. Must be able to understand all insurance updates. Must be able to concentrate on work tasks amidst distractions. Must exert self-control in difficult situations. Consistently projects a positive image of the facility.

Education/Experience:

High School diploma or GED is required. One year experience in data processing. Prefer one year of patient service experience in a health care organization preferably in a medical office setting Knowledge of medical terminology and anatomy Experience in registration and insurance verification is preferred. Experience in medical billing is preferred. Computer skills are essential. Experience in Epic with both HB and PB a plus.

Required Credentials (Licensure Certification or Registration):

Certified Professional Coder CPC) Certification

Employment Variables:

Work is performed in an office environment. Work hours vary according to the workload and supervisory scheduling.

Initial Tuberculosis (TB) test and drug screening are required by Winner Regional Health. Rubella titer will also be drawn upon hire and immunization is required if no past exposure or indication of immunization.

Required to wear name tag provided by WRH and to follow the dress code of WRH.

Job Knowledge and Skills:

Ability to read write speak and understand the English language and follow oral or written instruction. Excellent oral and written communication skills work with customers and co-workers in a professional manner.

Direct Supervisor:

Director of Revenue Cycle

PART II: CODE OF CONDUCT

Honesty - We will do the right thing at all times even if it is difficult maintaining strong ethical practices. We protect the confidentiality of others including patients staff and the facility as a whole. We will take responsibility for our actions.

Expertise - We will demonstrate superior judgment training and skill at all times demonstrating professionalism while doing so. We will perform all aspects of our job to the best of our ability utilizing all resources and tools available.

Approachability - We will be non-judgmental friendly and open and willing to listen to everyone we come into contact with while performing our duties. We are humble and learn from others.

Respect - We will be understanding and sensitive to others feelings; caring and responding in a manner that sets them at ease keeping the situation in perspective without minimizing others feelings or reactions. We will listen to others with full attention in a sincere civil fashion being careful not to be judgmental of the speaker. We maintain composure when facing conflict and avoid jumping to conclusions and defaming anothers name.

Teamwork - We willingly work together with a common approach trusting and supporting members of our organization using our skills and resources sharing information to achieve a common aim.

PART III: ESSENTIAL FUNCTIONS

Essential functions are critical or fundamental to the performance of the job. They are the major functions for which the person in the job is held accountable. Following are the essential functions of the job along with the corresponding performance standards.

Function Explanation

Coding Duties (CPC)

• Code physician professional services accurately and in a timely manner.
• Maintain and routinely work queues and follow up on coding denials.
• Verifies accuracy of patient information in the database as needed.
• Demonstrates ability to review patient related correspondence literature and reports.
• Promptly investigates problems and demonstrates ability to resolve routine problems and appropriately refers complex problems as appropriate to the Site Supervisor.
• Participates with other staff to seek account resolution
• Updates patient account database.
• Provides CPT and ICD-10 coding on clinic charges.
• Attend required meetings and participate in committees as requested.
• Works with physician/provider to resolve coding issues.
• Ensures that provider education and updates are provided at opportune times
• Handles coding/billing calls and questions from patients and other staff to seek account resolution.
• Submit State lab bills lab charges (Chlamydia/GC).
• Sanford Pathology Bill
• Medicaid referral cards
• Answers billing questions

Customer Service

• Introduces self immediately when working with customers.
• Help create a positive experience when interacting with patients visitors and coworkers and demonstrates effective listening skills.
• Meets internal and external customer requests by either completing the task or seeking the appropriate assistance of others.
• Demonstrates understanding of Performance Improvement principles and activities by participating and/or supporting department/organizational performance improvement initiatives.
• Demonstrates compliance with the Code of Conduct through actions behaviors and words.
• Greets every employee and customer with a warm and friendly smile.

Computerized Insurance Records

• Accurately updates computer system to reflect correct patient demographics and insurance regarding hospital and clinic charges
• Completes demographic updates in a timely manner and prioritizes duties based on date of service and revenue amounts.
• Reviews updated accounts receivable to ensure that all charges have been filed to correct insurance carrier.
• Make changes/corrections as needed.
• Corrects patient or insurance carrier as needed to receive current and correct demographic and insurance information.
• Communicates need for assistance and pertinent insurance updates to customer service staff.
• Meet or exceed performance standards set by the department.
• Ensures correct reparation of charge tickets has been completed for data entry including hash totals when requested

Professional Development

• Identifies own learning needs and goals and develops a plan to meet them
• Accepts coding assignments as able to enhance learning
• Participate in learning opportunities

Additional Duties

• Identifies accounts that have had no insurance response and phone payer as a follow up.
• Processes refunds to patients and insurance companies
• Enters accurate notes on patient accounts.
• Attends required meetings and participates on committees as requested.
• Respects at all times the confidentiality of patient and uses complete discretion when discussing patient
• Other tasks as assigned.

PART IV: COMPLIANCE

Compliance

• Must comply with the Corporate Compliance Policy and all laws rules regulations and standards of conduct relating to the position.
• The employee has a duty to report any suspected violations of the law or the standards of conduct to the Compliance Officer or the Director of Revenue Cycle.

PART V: PHYSICAL AND MENTAL REQUIREMENTS

General Activity

• In a regular workday employee may:

Sit 2-3 Hours at a time; up to 8-10 Hours during the day

Stand 0-2 Hours at a time; up to 0-2 Hours during the day

Walk .5 Hours at a time; up to 1 Hours during the day

Motion

• Employee is required: (In terms of a regular workday Occasionally equals 1% to 33% Frequently 34% to 66% Continuously greater than 67%.)

Bend/Stoop Occasionally

Kneel Duration 30 sec Occasionally

Squat Occasionally

Balance Occasionally

Crawl Distance Occasionally Twist Occasionally

Climb Height Occasionally

Keyboarding/Mousing Frequently

Reach above shoulder level Occasionally

Physical Demand

Employees job requires he/she carry and lift loads from the floor from 12 inches from the floor to shoulder height and overhead. Employees job requires a pushing/pulling force to move a load (not the weight of the load).

Physical Demand Classification: Carrying/lifting weight and pushing/pulling force:

• Sedentary Occasionally 10 lbs.
• Frequently Negligible
• Constantly Negligible

Sensory Requirements:

• Yes/No Explanation (if Yes)

Speech - Expressing or exchanging ideas by means of the spoken word. Those activities in which they must convey detailed or important spoken instructions to other workers accurately loudly or quickly.

Yes

Ability to exchange information with staff and patients on the phone. Responds to patients concerns and questions. Extensive interactions with customers co-workers and supervisors in person.

Vision (VDT) - Are there specific vision requirements for the job

Yes

Must be able to read numbers and names. Must be able to distinguish colors and view a computer screen Must be able to edit and proof work and to discern small print and a variety of handwriting. Must be able to operate office equipment.

Hearing - Ability to receive detailed information through oral communications and to make fine discriminations in sound; i.e. making fine adjustments on machine parts using a telephone taking blood pressures.

Yes

Vital for communications with other clinic staff and patients directly or via telephone

Environmental Factors

• Yes/No Explanation (if Yes)

Working on unprotected heights No

Being around moving machinery No

Exposure to marked changes in temperature and humidity No

Driving automotive equipment Yes To deliver papers for signatures

Wearing personal protective equipment No

Exposure to atmospheric conditions (i.e. fumes dust odors mists gases or poor ventilation) No

Exposure to extreme noise or vibration No

Exposure to blood body fluids and waste No

Exposure to radiation No

Exposure to other hazards (i.e. mechanical electrical burns or explosives) No

Emotional/Psychological Factors

• Yes/No Explanation (if Yes)

Stress: Exposed to stressful situations

Yes

Must be able to effectively deal with concerns of upset patients or other clinic staff. On occasion when information is needed and not available. Working with a variety of coworkers at one lime. High accountability. Must be able to establish priorities Works in an environment of frequent interruptions. May be monitored for productivity and quality.

Concentration: Must be able to concentrate on work tasks amidst distractions.

Yes

Work must be done accurately. Constant interruptions in a multi-task clerical environment.

Must exert self-control.

Yes

Must be able to display control and confidence under stress or amidst distractions.

PART VI: JOB RELATIONSHIPS

Supervises 1 No supervisory responsibilities

• 0 Supervisory responsibility

# Direct Reports: depends upon shift

# Indirect Reports:

Age of Patient Populations Served 0 Neonates: 1-30 days

0 Infant: 30 days - 1 yr

0 Children: 1- 12 yrs

0 Adolescents: 13- 18 yrs

0 Adults: 19- 70 yrs

0 Geriatrics: 70 yrs

1 All

0 Not applicable

Internal Contacts 0 Patients

1 Providers: (i.e. Physicians Therapists Social Workers)

1 Staff: (i.e. clinical and administrative support staff)

0 Volunteers

0 Others:

External Contacts 0 Patients

0 Families/Significant Others

1 Providers

1 Vendors

1 Community and Health Agencies

1 Regulatory agencies

0 Other: Job Applicants