Position Summary

The Certified Procedural Coding Specialist will read and interpret
health record documentation to identify all diagnoses and procedures
that affect the current inpatient/outpatient encounter visit; assess the
adequacy of health record documentation; apply knowledge of anatomy and
physiology, clinical disease processes, pharmacology, and diagnostic and
procedural terminology to assign accurate codes to diagnoses and
procedures.

Primary Duties

  Essential Functions:

• Maintains accurate patient accounts including deductibles, co-payments, co-insurance, termination dates, effective dates, pending claims, etc.
• Processes claims for secondary insurance companies and conducts research on any claims denied by insurance companies.  Matches remit copy with hard copy claim.  Keys in account numbers.  Checks balances due from secondary insurance companies.  Verifies benefit determinations.
• Initiates appeal process for denied claims.
• Processes all monetary transactions in an appropriate manner and reports daily to supervisor.
• Assists patients in a professional and courteous manner with their questions and concerns.
• Works with insurance companies to verify patient information or to adjust claims.
• Works insurance tracking report to ensure insurance companies process claims in a timely manner.  Tracks refilled claims; ensures accounts are followed up on in a timely manner.
• Codes and abstracts all diagnoses and procedures from physicians’ dictation and according to ICD-9-CM and CPT-4/HCPCS hospital coding policies and procedures, and Federal and State Coding & reimbursement guidelines with 95% accuracy.
• Initiates physician interaction when ambiguous or conflicting information is in the medical record.
• Exhibits knowledge and aptitude regarding coding software and resources for accurate code assignment.
• Provides backup to other members of department as needed.
• Other assigned duties as directed by supervisor based on demonstrated competency