The Certified Procedural Coding Specialist will read and interpret health record documentation to identify all diagnoses and procedures that affect the current inpatient/outpatient encounter visit; assess the adequacy of health record documentation; apply knowledge of anatomy and physiology, clinical disease processes, pharmacology, and diagnostic and procedural terminology to assign accurate codes to diagnoses and procedures.
- Maintains accurate patient accounts including deductibles, co-payments, co-insurance, termination dates, effective dates, pending claims, etc.
- Processes claims for secondary insurance companies and conducts research on any claims denied by insurance companies. Matches remit copy with hard copy claim. Keys in account numbers. Checks balances due from secondary insurance companies. Verifies benefit determinations.
- Initiates appeal process for denied claims.
- Processes all monetary transactions in an appropriate manner and reports daily to supervisor.
- Assists patients in a professional and courteous manner with their questions and concerns.
- Works with insurance companies to verify patient information or to adjust claims.
- Works insurance tracking report to ensure insurance companies process claims in a timely manner. Tracks refilled claims; ensures accounts are followed up on in a timely manner.
- Codes and abstracts all diagnoses and procedures from physicians dictation and according to ICD-9-CM and CPT-4/HCPCS hospital coding policies and procedures, and Federal and State Coding & reimbursement guidelines with 95% accuracy.
- Initiates physician interaction when ambiguous or conflicting information is in the medical record.
- Exhibits knowledge and aptitude regarding coding software and resources for accurate code assignment.
- Provides backup to other members of department as needed.
- Other assigned duties as directed by supervisor based on demonstrated competency
- Knowledge of medical billing and insurance procedures.
- Knowledge of ICD-9 and CPT coding.
- Correct telephone etiquette.
- Computer programs and applications.
- Operation of basic office machinery, including a copy machine, fax machine, and telephone.
- Good telephone skills, including correct etiquette.
- Understand and interpret policies and regulations.
- Prepare documents in response to complaints and inquiries.
- Examine documents for accuracy and completeness.
- Communicate effectively and work with others.
- To deliver quality customer service to patients and coworkers.
- ???????Education: High School diploma or equivalent required. Associate degree preferred.
- Licensure/Certification: Certified Professional Coder (CPC) certification required.
- Experience: Minimum of one year experience in clinic or physician practice medical billing/insurance, medical records and/or coding using ICD-9 and CPT coding systems required.