Medical Billing and Coding Specialist
8 hours ago
This is a critical role in the revenue cycle process, ensuring timely and accurate submission of medical claims. As a certified specialist, you will play a key part in optimizing revenue cycles while maintaining compliance with regulatory standards.
Key Responsibilities:
- Analyze and 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.
- Develop and maintain effective communication with clinical staff, insurance plans, and hospital systems.
- Assist with billing and credentialing tasks as needed.
- Maintain confidentiality and safeguard patient information.
Requirements:
- Background in a medical field.
- Proficient in the English language, both written and verbal.
- Certification as a Certified Professional Coder (CPC) or Certified Coding Specialist-Physician (CCS-P) from AAPC or AHIMA (preferred, not required).
- At least 2 years of experience in medical coding and billing, with a focus on physician and home health coding.
- Knowledge of medical terminology, anatomy, and physiology, as well as coding systems and guidelines (ICD-10, CPT-4, HCPCS).
- 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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