Position Summary

Responsible for application and maintenance of medical necessity software, insuring compliance relating to Medicare billing requirements, conducting internal audits relating to medical necessity, analyzing medical necessity denials, communicating and updating staff on changes as they relate to HCPCS and revenue code updates, additions and deletions as it relates to medical necessity.

Primary Position Responsibilities

Has strong knowledge of coding regulations and guidelines for all physician practice specialties, takes advantage of outside education to enhance specialty coding skills , shares and updates staff on coding changes and other job related information Communicates with specialists to gain coding knowledge by either shadowing them or meeting with them, keeps abreast of new or unique procedures and corresponding coding requirements Provides support and ongoing physician training by meeting with providers via one on one , email, written and/or verbal communication and answering the requested coding needs of the specialist physician practices Initiates independent efforts to keep knowledge base current , responds to CBO needs in coding outpatient services for specialist offices Actively participates in scheduling education sessions, Designs coding education curriculums to meet the needs of physician practices Promotes education for self and others by means of webinars and teleconferences offered by Medicare General & Medicare Compliance: Medicare and Coding Compliance Reviews and monitors MR for coding compliance, use of Medicare website tools, educates providers and staff on applicable billing coding and regulations and updates, Provides corrective measure plan and suggestions to Department Director and Administrative Director Responsible for maintaining ,tracking, trending and communicating audit results on monthly basis and providing education to physicians and staff on audit outcomes and improvement measures.

Qualifications

Minimum Education: Required: High School Diploma or Equivalent, Certificate and/or Advanced Specialized or Technical Training Preferred: None
Minimum Years of Experience (Amount, Type and Variation): Required: Three years physician billing or the equivalent required. Medicare billing experience preferred. Preferred: None
License, Registry or Certification: Required: Medical coding certification, one of the following CCA,CCS,CPC in good standing Preferred: Billing Compliance, CDM experience, CPAT, CPAM preferred
Knowledge, Skills and/or Abilities: Required: Demonstrates strong analytical skills. Demonstrates strong written and verbal communication skills (Word/Excel). Demonstrates ability to interact successfully with persons at all levels of the organization. Demonstrates ability to work independently in a productive, goal-oriented manner Preferred: Knowledge of managed healthcare plans, Medicare and Medicaid regulations. Knowledge of NextGen- software’s coding compliance module and charge master for insurance billing.