Education and Experience-

Education:

• High School Diploma/GED Required.

Experience:

• Minimum of one (1) year work experience as a Medical Coder/Biller in a hospital setting
• Knowledge of medical terminology and coding, including ICD-10, CPT, and HCPCS required
• Knowledge of the principles of medical billing and coding; federal and state laws and regulations relating to medical billing
• Demonstrated problem-solving skills in order to resolve complex billing issues required
• Knowledge of local and major national medical insurance practices
• Demonstrates the ability to use a personal computer and various software programs applicable to the position
• Ability to multi-task, prioritize needs to meet required timelines

Licenses/Certifications: 

• Coding Certification from AAPC or AHIMA required

Duties and Responsibilities-

Essential Duties:

• Responsible for reviewing documentation to make sure the documentation supports the levels or types of service billed/or assign level service based on documentation. Assigns CPT, HCPCS, ICD-10 codes, and ASA codes.
• Performs coding activities to assure accurate completion of coding for all patient records; including reviewing each for charge submission for accuracy, addressing NCCI edits, and adding appropriate modifiers.
• Potential to provide physician education on billing and coding practices and advise physicians of coding changes or changes in regulations.
• Ensure compliance with medical coding policies and guidelines; understands the application of each code set.
• Provides feedback to management regarding any issues or repetitive errors that may be encountered during claim review and submission.
• Completes follow-up of claims on a timely basis according to the CVH productivity guidelines for account follow-up goals.
• Reviews system-generated worklist, reports, and/or aged trial balances to resolve accounts that have not been paid in the appropriate time frame, based on specific third-party payer contracts and guidelines.
• Contacts assigned payer representatives to determine when payment will be made and if other information is required to adjudicate a claim.
• Reviews payment denials and discrepancies identified through Explanation of Benefits, Remittance Advices, or payer correspondence and takes appropriate actions to correct these accounts.
• Documents account activities in an accurate and timely manner in accordance with PFS quality standards.
• Applies a high level of knowledge of respective insurance billing regulations and guidelines.  Researches these guidelines when required on payer websites where available.
• Ensures compliance with all state and federal billing regulations and reports suspected compliance issues to their respective Leads/Supervisors/Managers.
• Conducts inquiries via telephone, mail, and fax, or electronically through payer websites or e-mail for follow-up of unresolved accounts.
• Contacts patients for additional information in order to ensure claims are processed and paid.
• Works with various departments throughout CVH to obtain additional information for the billing and follow-up process.  Works with management and PFS staff to improve processes, increase accuracy, create efficiencies and achieve the overall goals of the department.
• Maintains proficiency and levels of knowledge with all systems required for task completion.
• Attends required training and completes online training and surveys as required.
• Attends meetings with payer representatives and/or vendors to address outstanding issues and learn about new regulations and guidelines.
• Reviews and analyzes patient issues to fully understand the patient’s concern.  Forwards or routes patient calls or concerns when required to an appropriate Patient Accounts Services resource for assistance
• Prepares appeal letters and reconsiderations both on paper and online, in a professional and factual manner resulting in claim adjudication.
• Other duties as assigned.

Coquille Valley Hospital provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability or genetics. In addition to federal law requirements, Coquille Valley Hospital complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.

Coquille Valley Hospital expressly prohibits any form of workplace harassment based on race, color, religion, gender, sexual orientation, gender identity or expression, national origin, age, genetic information, disability, or veteran status. Improper interference with the ability of Coquille Valley Hospital’s employees to perform their job duties may result in discipline up to and including discharge.