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Managed Care/Coding Specialist, CPC or HIMAC
1 month ago
Job Type Full-timeDescriptionJOB SUMMARYResponsible for performing the duties related to obtaining preauthorization for inpatient admissions, outpatient surgeries, and advanced imaging procedures; insurance follow-up specific to coding denials; identifying revenue opportunities as the result of reimbursement trending/audits; meeting with MedPro Representatives to discuss carrier issues; responding to questions from patients, Practice Managers, and medical departments; and performing other related duties as requested by direct manager.ESSENTIAL DUTIES AND RESPONSIBILITIESUtilizes the Managed Care Work list to track receipt, delays and completion of requests, to prioritize requests and obtain authorizations at minimum one week prior to scheduled date of service, as possible.Works Eligibility and Authorization reports for the Diagnostic Center.Analyzes data recorded in the Managed Care Work list to provide recommendations for process improvements.Performs coding duties with little supervision, functioning in an autonomous capacity to manage time producing an appropriate volume and quality of work product.Works coding-related claim denials for departmental services by assessing source documentation to determine accurate CPT, ICD-9-CM, ICD-10-CM and/or CPT/HCPCS codes and/or modifiers. Modifies codes as appropriate and make recommendations in claim notes regarding whether to re-file to the insurance carrier or adjust claims. Tracks activity to identify carrier trends. Makes recommendations regarding trends to the department director.Reviews and works Diagnostic Center ALI and Context claim coding edits daily.Reviews and works Denial Reports for the Diagnostic Center.Uploads Diagnostic Center files into electronic medical record daily.Updates Diagnostic Center patient accounts with the correct insurance information.Independently assesses carrier trends, on a proactive basis and communicates information to appropriate personnel.Facilitates communication among parties impacted by coding related matters to produce a timely and satisfactory solution.Stays informed of insurance requirements and industry related news/policy changes as relate to coding.Maintains continuing coding education (i.e. seminars, online training, industry newsletters and bulletins, etc.)Responds to questions from patients, or medical department staff related to insurance or account A/R activity in a courteous and professional manner.Completes assigned reports and/or projects within deadlines.Maintains a positive & cooperative working relationship with internal and external customers.Communicates in a professional manner with staff in medical offices and co-workers.Stays informed of current insurance carrier requirements regarding pre-authorization of services.Ensures backup personnel are trained to work ALI, Context, Eligibility and Authorization, and Denial reports for absences.Performs as an PSR in the absence of personnel.Performs other duties as assigned by manager.CORPORATE CULTURE RESPONSIBILITIESFollow established corporate and department-specific policies and procedures.Attend all corporate and department-specific required training.Uphold MCC's Purpose, Values, and Vision.Abide by MCC's Corporate Culture Responsibilities.Perform other duties as may be assigned cheerfully and willingly. RequirementsEDUCATION/EXPERIENCE REQUIREMENTS Minimum education requirement is high school diploma or GED. Certification as a Certified Professional Coder or Certified Coding Associate. Minimum of 2 years experience in healthcare insurance area.KNOWLEDGE, SKILLS AND ABILITIES Display customer services skills, strong interpersonal skills, close attention to detail, and excellent verbal and written communication skills. Be a person of integrity and character, willing to embrace change and make a positive impact in the lives of patients and co-workers. Ability to work with staff members at all levels of the organization in a cooperative, team-oriented manner. Be able to work hours necessary to accurately and thoroughly perform duties. Good organizational skills and the ability to adapt to frequent changes. Proficient in use of the following computer / software: PPP, Horizon System, Microsoft Excel and Word. Proficient in use of English language both in written and verbal communication. Must be able to communicate with individuals of varying socio-economic backgrounds. Displays ability of giving full attention to what other people are saying, taking time to understand the points being made, asking questions as appropriate, and not interrupting at inappropriate times. Professional demeanor and recognition of privacy considerations for patients and families. Must be committed to the protection of confidential information, records and/or reports. Ability to maintain focus while working in close proximity to others.PHYSICAL REQUIREMENTS OF THE ESSENTIAL JOB FUNCTIONS Strength (Lift/Carry/Push/Pull): Sedentary (exerting up to 10 pounds of force occasionally) Standing/Walking: Occasionally; activity exists up to 1/3 of the time Keyboarding/Dexterity: Frequently; activity exists from &fac34; of the time Ability to look at a computer screen for extended periods. Ability to perform constant repetitive hands and finger motions. Ability to work in various positions (standing, sitting, bending, and walking) for extended periods of time. Talking (Must be able to effectively communicate verbally): Yes Seeing: Yes Hearing: YesEMOTIONAL REQUIREMENTS OF THE ESSENTIAL JOB FUNCTIONS Must exhibit stable work behaviors daily. Must possess adequate individual coping skills. Ability to remain calm and professional regardless of workload or time constraints. Must be able to work under stress and remain calm and professional.WORK ENVIRONMENT Exposed to frequent and constant interruptions in daily functions/schedule. Must be available to customers and staff throughout the day. Required to work extended hours to meet department needs.
