PHYSICIAN SERVICES CODING AUDITOR

Job Responsibilities

Abstracts pertinent information from patient records for provider services. Reviews the International Classification of Diseases, Clinical Modification (ICD), Current Procedural Terminology (CPT), or Healthcare Common Procedure Coding System (HCPCS) codes, including modifiers, assigned by providers. Works with providers to correct any codes or charges when errors are identified.

Reviews medical records for diagnoses that meet medical necessity according to the CMS Local Coverage Determination (LCD) and/or National Coverage Determination (NDC) guidelines.

Reviews and interprets provider notes using CPT and ICD coding books and/or software. Ensures codes are accurate and sequenced correctly in accordance with government and insurance regulations. Works with providers to correct any identified errors.

Conducts chart audits for provider documentation and recognizes when it is necessary to obtain further clarification from providers when documentation is inadequate or unclear and queries that provider for further clarification prior to releasing claim to payer.

Educates JMH Physician Network providers on new coding guidelines, CPT code additions/deletions/modifications, and ICD code additions/deletions/modifications.

Provides guidance and support for physician practices to ensure compliant coding and documentation practices are followed in accordance with CMS Rules and Regulations.

Works directly with Patient Accounts Department to prevent denials and ensure revenue integrity and provides support for providers to ensure charge capture of CMS quality payment incentive programs. Reviews insurance denials to analyze the causes & identify suitable solutions.

Performs daily review of claims in Electronic Medical Record (EMR) as assigned for coding review. Responsible for claim corrections and claim submissions as appropriate.

Performs daily review of claims in electronic claims scrubber as assigned for coding review. Responsible for claim corrections and claim submissions as appropriate.

May assist with training of new employees.

Performs other related duties as assigned.

Clearly communicates and continuously supports the Mission and Values of Johnson Memorial Health.

Conducts all activities in compliance with applicable laws, regulations, standards, and Johnson Memorial Health policies and procedures including Blood and Body Substance Precautions.

Education, Experience and Training:

High school diploma or equivalent required. Certified Professional Coder (CPC) from the AAPC or Certified Coding Specialist (CCS) or Certified Coding Specialist Physician (CCS-P) certification from the AHIMA is required or must be obtained within 1 year of hire. Additional certifications in designated specialty preferred (example: COSC, CGSC, CPMA, COBGC, CGIC, CEMC, CFPC, CPEDC, etc.). Previous medical billing experience preferred.

Schedule:

Monday - Friday 8:00am-4:30pm 80 hours per bi weekly pay period

Johnson Memorial Health