Senior Medical Claims Specialist
1 day ago
The role of a certified medical biller and coder is pivotal in ensuring the accurate and timely submission of medical claims. Proficiency in medical coding and billing processes optimizes revenue cycles while maintaining compliance with regulatory standards.
Key Responsibilities:- Abstract medical information from patient records for physician/NP visits and home health start-of-care visits.
- Accurately code diagnostic and procedural information in compliance with ICD-10, Home Health PDGM, CPT-4, HCPCS, MS-DRGs, APCs, and POAs following national coding guidelines.
- Document essential patient information including medication history, medical history, active diagnoses, and preventive care screens.
- Consult with medical providers to identify potential missing HCC diagnoses and ensure accurate documentation and code assignment.
- Review claims data to verify accurate coding and billing for all services and procedures.
- Collaborate with healthcare professionals to improve documentation, coding accuracy, and compliance.
- Stay current with changes in coding regulations and provide education and training as needed.
- Participate in Quality Assurance/Quality Improvement initiatives.
- Assist the Clinical Director in developing and achieving key performance indicators related to coding accuracy and compliance.
- Maintain effective communication with clinical staff, insurance plans, and hospital systems.
- Background in a medical field.
- Proficient in English language both written and verbal.
- Certification as a Certified Professional Coder (CPC) or Certified Coding Specialist-Physician (CCS-P).
- At least 2 years of experience in medical coding and billing with focus on physician and home health coding.
- Knowledge of medical terminology anatomy and physiology as well as coding systems and guidelines.
- Strong analytical skills and attention to detail.
- Proficiency with coding software tools and EHR systems.
- Knowledge of regulatory requirements and compliance standards.
- Excellent communication skills and ability to collaborate with healthcare professionals.
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