Certified Billing and Coding Specialist

SCOPE: Under minimal supervision performs periodic, comprehensive coding audits for all assigned regional oncologists (medical, radiation and surgical oncology).   Verifies charge documentation and charge submission processes are in compliance with Federal and State regulations, as well as payer guidelines. Coordinates efforts with manager and front office managers to ensure optimal revenue cycle processes and adherence to compliance and revenue cycle policies and procedures.  Provides effective educational feedback to physicians and staff on findings from audits and updates in Payer billing regulation.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

• Develops Audit and Education Programs

• Abstracts relevant clinical and demographic information from the medical record to assign current ICD and CPT codes in accordance with coding and reimbursement guidelines.

• Codes with an accuracy of 97% based on QA internal reviews

• Performs Evaluation and Management (E&M) audits for all assigned providers according to schedule established by State Business Office (SBO) Administrator

• Prepares reports of findings that details discrepancies and summarizes opportunities for improvement.   Identifies trends that could be perceived as non-compliant with local and federal regulatory guidelines. Recommends procedural improvements and training opportunities to management. Provides written audit reports to supervisor for review and approval

• Reviews approved audit findings with physicians and mid level providers (individually and in group settings) to discuss recommendations and improvement opportunities

• Performs Charge Capture Report audits for all regional providers (medical, radiation and surgery oncology)

• Provides formal coding education to physicians and mid levels

• Provide training for practice staff on coding and revenue process improvements

• Recommends and documents audit procedures, standard reports and metrics in order to improve business revenue

• Maintains the confidentiality of medical information contained in each record

• Assists with other audits such as hospital visits, consultations, compliance, reimbursement and others as assigned

MINIMUM QUALIFICATIONS:

Bachelor’s degree required.  Current Certified Professional Coder (CPC) accreditation required. Minimum of five (5) to seven (7) years physician billing, coding audit experience. Must possess broad knowledge of Managed Care and HMO policies and procedures and Medicare benefits. Must possess strong knowledge of current versions of ICD-10, CPT-4 and HCPCS. CPC mandatory for position. Prior experience with presenting/educating in group environment (including physician and administrative staff) preferred.  

PHYSICAL DEMANDS:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to sit and use hands to finger, handle, or feel.  The employee is occasionally required to stand, walk, and reach with hands and arms.  The employee must occasionally lift and/or move up to 30 pounds.  Requires vision and hearing corrected to normal ranges.