•Conducts coding and documentation reviews of medical/patient records to ensure provider billing practices are complaint with applicable rules and regulations. Ensures accurate and compliant charge capture.
•Evaluates procedure codes and diagnosis on an ongoing basis and recommends corrections and changes for continuous improvement. Conduct audits.
•Serves as a knowledge resource for coding and billing auditing functions.
•Provide routine oversight to ancillary and clinical departments related to charge capture and charge reconciliation to ensure all services rendered are captured and posted to the patient s account accurately and on a timely basis.
•Identifies potential HIM coding issues pertaining to high revenue opportunities, missing or incorrect diagnosis and procedure codes.
•Manually distribute account exceptions to the appropriate clinical departments when required for resolution within a reasonable time frame.
•Participate in testing of upgrades and system enhancements as they relate to charge capture.
•Monitor effectiveness of departmental corrective action plans regarding charge capture and charge reconciliation.
•Review new edits/rules on a monthly basis to ensure changes will apply to hospital charging practices; alert assigned account manager regarding rules that apply so they can be added to our queue.
•Create and manage special projects to improve revenue cycle outcomes.
•Identify, review and summarize results for improvements needed and successes on a quarterly basis.
•Assist clinical departments with root cause analysis and process improvement if needed.
•Provides training to ensure accurate charge capture and consistency clinical documentation; in the use of charge tools and charge entry systems.
•Promotes individual professional growth and development by meeting requirements for mandatory/continuing education and skills competency; supports department-based goals which contribute to the success of the organization; serves as preceptor, mentor and resource to less experienced staff.
Data Coordinating: Analytical ability in coordinating, handling multiple projects, and prioritizing reports Microsoft Office Suite: Word, Excel, PowerPoint, Outlook, Software: SIS, HEMM, HBOC/STAR, EPIC, Craneware, ChartMaxx, Med Assets On Ramp, UNOS (UNET), Cerna, Health Quest, TransChart, Care4, Sovera, CMS Medical Terminology, SAP, BI Analytics, Meditech, KnowledgeSource
CPC (Certified Professional Coder) 01532527
CMBS (Certified Medical Billing Specialist) 1988825
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