Certified Coding Analyst
- High school graduate or equivalent
- Previous experience in the medical field is preferred but not required.
- Basic knowledge of the use and operation of general office equipment (i.e. phone, FAX, PC, and copier).
- Working with the public in a courteous and professional manner.
- Certification from the American Academy of Professional Coders (AAPC) or the American Health Information Management Association (AHIMA) - Required
- Certification from the AAPC as a Certified Professional Medical Auditor (CPMA), required.
- Minimum of two (2) years coding and billing experience in physician practice preferred.
- Experience with Microsoft Word, Excel and Windows based applications
- Working knowledge of federal, state and local regulations, guidelines, and standards, including a working knowledge of HIPAA rules and regulations preferred but not required
- Evidence of job stability
- Necessary Skills:
- Ability to maintain a positive attitude and provide great customer service under stressful situations.
- Ability to communicate in a clear, concise, and pleasant manner in both verbal and written form.
- Ability to multi-task.
- Ability to adapt quickly to change.
- Ability to work both independently and with physicians, clinical department staff and co-workers.
- Ability to use and manage time efficiently.
- Ability to follow the direction of supervisory personnel.
- Ability to speak in a classroom setting.
- Ability to provide coding guidance (verbal and written) to physicians and Advance Practice Providers
General Summary of Duties
This position will perform a variety of clerical duties necessary to the daily operation of the Business Office. These duties will include but are not limited to the following:
Act as a resource to the Central Business Office (CBO) and clinical departments for coding and documentation matters. Assist in the communication and/or denial process for reimbursement and coding issues with third-party payers and governmental payers. Assist in maintaining the integrity of the procedure codes utilized in the Athena billing system. Assist in medical record documentation reviews conducted by the Clinic’s Compliance Officer.
Essential Job Functions:
- Act as a coding and medical record documentation resource for physicians, clinical department staff and Business Office staff.
- Research and communicate revisions to coding and billing guidelines (the American Medical Association’s CPT, ICD-9-CM / ICD-10-CM. HCPCS II, the Centers for Medicare and Medicaid (CMS), etc.)
- Provide educational sessions for physicians, clinical and billing staff.
- Assist in maintaining the integrity of the procedure codes utilized in the billing system.
- Assist in the communication process of resolving reimbursement or denial issues with contracted payers.
- Assist in updating the clinical department billing slips
- Assist in the medical record documentation reviews conducted by the Clinic’s Compliance Officer.
- Assist in the appeal process for denials received as they relate to coding (e.g., unbundling, CPT/diagnosis inconsistent, etc.
- Respond to third-party payer and governmental coding audits, including but not limited to RAC and CERT audits.
- Provide coding guidance on claims placed in the CODINGRVW worklist in Athena.