Ambulatory Billing Specialist
4 weeks ago
Job Summary
Evaluate patient records to identify and resolve inaccurate charges, ensuring compliance with HIPAA regulations. Abstract pertinent data from clinical records, reviewing them for reimbursement purposes and quality control.
Responsibilities
- Read and interpret outpatient, series, and ED medical record entries to identify diagnoses and surgical procedures.
- Assign ICD-10, ICD-9-CM, and CPT-4 codes in compliance with recognized coding principles and department policies.
- Determine diagnostic and procedural sequencing in compliance with UHDDS guidelines.
- Utilize APCpro features of 3M with encoder and grouper software to identify modifiers, make changes to charges, and prepare clean claims for billing.
- Enter abstracted and coded data into the computer system accurately and timely.
- Comply with HCFA's Medicare code edits.
- Ensure quality and accuracy of records for reimbursement.
- Verify and correct data discrepancies by communicating with physicians and hospital personnel.
- Participate in the Coding Hotline, providing coding advice and liaison services between coding and other departments.
Knowledge, Skills & Abilities
Patient Group Knowledge: The employee must possess knowledge and skills necessary to provide developmentally appropriate assessment, treatment, or care as defined by the department's identified patient ages.
Specifically, the employee must be able to demonstrate competency in: 1) ability to obtain and interpret information in terms of patient needs; 2) knowledge of growth and development; and 3) understanding of the range of treatment needed by the patient.
Must demonstrate competency through an initial orientation and ongoing competency validation to independently perform tasks and additional duties as specified in the job description and the unit/department specific competency checklist.
Common Duties and Responsibilities
- Maintain and document all applicable required information.
- Demonstrate positive customer service and co-worker relationships.
- Comply with the company's attendance policy.
- Participate in continuous quality improvement activities of the department and institution.
- Perform work in a cost-effective manner.
- Perform work in accordance with all departmental pay practices and scheduling policies.
- Follow organizational and departmental policies and procedures.
- Perform related duties as assigned.
Education
- High School Diploma or GED (Required)
Experience
- None
Credentials
- No Certification, Competency or License Required
Work Schedule
Days
Status
Full Time Regular 1.0
Location
Beckley-275 Dry Hill Road
Talent Acquisition Specialist
Tamara B. Young
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