Job Summary: Reviews medical records in support of concurrent, focused and retrospective audits. Provides feedback to hospital clients regarding documentation and lost charge capture. Monitors adherence to standardized charging practices, identifies trends and changes, investigates the root cause and provides reporting including potential solutions. Identifies opportunities for revenue enhancement within service lines in order to obtain additional reimbursement for Praxis Healthcare Solutions, LLC. Clients. Team member will also be responsible for reviewing payment denials related to coding and perform medical record review and then providing recommendations/findings for any appropriate billing corrections.
Duties and Responsibilities (not limited to):
- Reviews patient medical records to ensure the appropriate charges and codes are assigned to treatments, surgical procedures and nonsurgical procedures for facility-based services. Ensures associated charging and documentation practices comply with regulations.
- Provides detailed feedback regarding documentation and charge capture.
- Identifies trends and changes in hospital billing charge capture, observes and investigates the root causes at the charge entry level and summarizes findings and proposed solutions for leadership.
- Identifies opportunities for revenue capture related procedures and policies.
- Reviews medical records in support of concurrent, focused and retrospective audits.
- Validate the accuracy of a denial due to potential coding errors
- Based on the detailed finding of the coding denial, initiate all related and supporting documentation needed for inclusion in the appeal letter
- Write and prepare a segment of formal appeal letters to payers
- Identify and recommend any applicable coding corrections. If coding change appropriate and approved by client, initiate coding corrections to the claim and rebill
- Perform other required duties in a timely, professional, and accurate manner.
- Document all activity taken on an account in the patient account notes.
- Conducts appropriate account activity on accounts by contacting government agencies, third party payors, and patients/guarantors via phone, e-mail, or online. Continue collection activity until account is resolved.
- Responsible for maintaining inventory and that daily productivity standards of assigned accounts are met.
- Identify payor issues and trends and escalate issues to Management
- Perform special projects and other duties as needed. Assists with special projects Ensure compliance with State and Federal Laws Regulations for Managed Care and other Third Party Payors.
KNOWLEDGE, SKILLS, ABILITIES:
- Must be able to communicate effectively and professionally with strong attention to details and problem solving both verbally and written.
- Ability to prioritize work and meet deadlines is required.
- Ability to operate common computer systems, utilize hospital collection system and business software is required.
- Intermediate understanding of Explanation of Benefits form (EOB), Managed Care Contracts, Contract Language and Federal and State Requirements
- Knowledge of hospital billing form requirements (UB-04)
- Knowledge of healthcare billing and reimbursement including standard billing rules
- Current and active certified coder with current knowledge of coding guidelines. Must already be ICD 10 Certified either currently or prior to implementation if ICD 10
- Knowledge of documentation guidelines and audit skills
- Intermediate Microsoft Office (Word, Excel) skills
- Advanced business letter writing skills to include correct use of grammar and punctuation
- Understanding of the revenue cycle process
- Strong interpersonal skills
- Above average analytical and critical thinking skills
- Ability to make sound decisions
- Understanding of EOB, hospital billing form requirements (UB04) and HCFA 1500 forms.
Include minimum education, technical training, and/or experience preferred to perform the job.
- Minimum of 4 – 5 years’ experience as a certified coder
- Certified Medical Coder (CMC) or Certified Coding Specialist (CCS) or Certified Professional Coder (CPC) or Certified Coding Associate (CCA)
- RN preferred
- Strong analytical skills and strong proficiency in Microsoft Office Tools
- 3-5 years medical claims and/or hospital collections experience or prior experience in similar position preferred