Louisville, KY, United States of America
The Coder reviews, analyzes, and codes diagnostic and procedural information that determines Medicare, Medicaid and private insurance payments. This role is responsible for coding, charge entry, Accounts Receivable (A/R) follow-up and reimbursement management. This position also ensures compliance with established coding guidelines, third party reimbursement policies, regulations and accreditation guidelines.
Essential Duties and Responsibilities
Assigns and sequences codes to diagnoses and procedures for documented information. Assures the final diagnoses and operative procedures as stated by the provider are valid and complete. Pulls all necessary information from health records to identify secondary complications and co-morbid conditions
Abstracts all necessary information and assigns codes, which most accurately describe each documented diagnoses, procedure and special therapy according to established guidelines
Determines the final diagnoses and procedures stated by the provider are valid and complete
Performs a comprehensive review for the record to assure the presence of all component parts such as: patient and record identification, signatures and dates where required, and other necessary data in the presence of all reports which appear to be indicated by the nature of the treatment rendered
Evaluates the record for documentation consistency and adequacy. Ensures that the final diagnosis accurately reflects the care and treatment rendered. Reviews the records for compliance with established third party reimbursement agencies and special screening criteria
Analyzes provider documentation to assure the appropriate Evaluation & Management (E & M) levels are assigned using the correct CPT code
Works with Clinical Operations staff to ensure that any new programs and services are billable
Ensures all billable activities are consistent with protocols and in compliance with government and payer regulations
Maximizes reimbursement in a cost-effective manner that is in compliance with federal/state and payer-specific billing requirements
Serves as a key resource for changes in fee schedule and coding guidelines from all payers
Troubleshoots, follow through and resolve issues related to the patient revenue cycle; develops and presents recommendations for further consideration by management
Strong alignment with SCHC Mission and demonstrates behaviors aligned with SCHC Statement of Faith and Core Values
Other duties as necessary to ensure successful attainment of SCHC goals and objectives
Job Qualifications and Requirements
Two years’ experience in medical office coding required
Certified Professional Coder Certificate preferred
Prior experience working in mental health and substance abuse disorder billing environment preferred
Excellent communication skills with patients and staff
Self-motivated with strong organizational and interpersonal skills
Proficient in computer applications – MS Word, Excel, PowerPoint, Outlook, Adobe and other office-related programs
Health, Dental, Vision, and Life Insurance
401(K) retirement plan with employer matching contributions
Paid Time Off (vacation and sick)
Working Environment and Physical Requirements
Work is primarily performed in an office environment but can occasionally be performed remote. Work may be stressful at times. Interaction with others is constant and interruptive.
Work may require sitting or standing for long periods of time; also stooping, bending and stretching for files and supplies. Occasionally lifting files or paper weighing up to 30 pounds. Requires manual dexterity sufficient to operate a keyboard, and operate office equipment as necessary. Requires normal visual acuity and hearing
Additional Information / Benefits
Benefits: Medical Insurance, Life Insurance, Dental Insurance, Vision Insurance, Paid Vacation, Paid Sick Days, Paid Holidays, 401K/403b Plan
This job reports to the Director of Finance
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