• Medical Coding
  • Assign appropriate CPT (Current Procedural Terminology), ICD (International Classification of Diseases), and HCPCS (Healthcare Common Procedure Coding System) codes to medical diagnoses, procedures, and services.
  • Follow coding guidelines and conventions to ensure accuracy and compliance.
• Review Medical Records
  • Analyze medical records and provider documentation to identify relevant codes.
  • Ensure coding reflects the medical necessity and completeness of services.
• Code Updates
  • Stay up-to-date with coding updates, guidelines, and regulations.
  • Incorporate changes into coding practices to maintain compliance.

Billing:

• Claims Preparation
  • Prepare and submit electronic and paper claims to insurance companies.
  • Verify the accuracy of claim information, including patient demographics, insurance details, and coding.
• Denials and Appeals
  • Monitor claim status and follow up on denied or rejected claims.
  • Prepare and submit appeals for denied claims, including providing necessary documentation.
• Patient Billing
  • Generate and send patient statements for outstanding balances.
  • Answer patient inquiries regarding bills, insurance coverage, and payment options.

Documentation and Compliance:

• Medical Records Review
  • Audit medical records for coding accuracy and compliance with regulatory requirements.
  • Identify potential documentation deficiencies and work with healthcare providers for clarification.
• Compliance
  • Ensure compliance with coding and billing regulations, including HIPAA, Medicare, and Medicaid guidelines.
  • Adhere to ethical coding and billing practices to prevent fraud and abuse.

Reporting and Communication:

• Reporting 
  • Generate reports on coding and billing performance, including Key Performance Indicators (KPIs).
  • Provide regular updates to management on billing and coding trends and issues.
• Communication
  • Collaborate with healthcare providers, clinical staff, and insurance companies to resolve coding and billing inquiries.
  • Maintain clear and effective communication with the healthcare team regarding documentation and coding concerns.
• Qualifications
  • High school diploma or equivalent; completion of a medical coding and billing program is preferred.
  • Certification as a Certified Professional Coder (CPC), Certified Coding Specialist (CCS), or similar coding certification is typically required.
  • Knowledge of medical coding systems (CPT, ICD, HCPCS) and familiarity with medical terminology.
  • Proficiency in medical billing software and electronic health record (EHR) systems.
  • Strong attention to detail and analytical skills.
  • Knowledge of healthcare compliance and regulations, including HIPAA.
  • Excellent communication and interpersonal skills.
  • Ability to work independently and as part of a team.