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Addresses denied claims, claims pended for medical necessity, and claims pending for supporting documentation and/or medical records by working with various teams such as clinic staff, registration staff, and coding staff to complete appeals.
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Performs computerized documentation on the electronic medical record (ARIA) that is timely and accurate, including order entry, billing and coding functionsEnsures appropriate treatment codes are charged for various treatment modalities and related positioning devices.
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Works directly with administrative and coding team to maintain appropriate documentation requirements when acting in the scribe role within the ambulatory setting. Updates knowledge of new ATC/medical practices and current literature appropriate to service and role to maintaincurrency of practice, expand knowledge and improve athlete care.
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Experience in using open-source coding languages for geospatial analysis. Participates in developing GIS data standards and operational procedures, follows data maintenance protocols, creates and maintains comprehensive metadata and documentation.
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Comprehensive knowledge of clinical documentation and coding, including CPT and HCPCS. Thorough understanding of the relationship between codes and revenue in the reimbursement process, specifically how revenue is generated from CPT codes and the HCPCS. Firm understanding of the Medicare IPPS, OPPS and ASC payment systems.
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Cost Control:Assist the Project Engineer to maintain an accurate project cost control system(budget change management, labor hour cost coding, vendor invoicing cost coding, Prepare Subcontractor Payment RequisitionsPrepare purchase orders and subcontracts under the direction of Project Manager.
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Monitors MDS and care plan documentation for all residents; ensures documentation is present in the medical record to support MDS coding. Completes accurate coding of the MDS with information obtained via medical record review as well as observation and interview with facility staff, resident and family members.
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Reviews medical record documentation to determine all appropriate diagnosis (including HCC Coding Hierarchical Condition Category), procedural and modifier code assignments. May assign and sequence basic CPT (Current Procedural Terminology) procedure codes (non-complex), and modifiers based on medical record documentation in accordance with Official Coding Guidelines, CMS regulations, Local Medical Review Policy (LMRP) guidance in encoder software and/or department coding policies and procedures.
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Queries: Queries the appropriate discipline for additional or clarifying documentation to ensure the accuracy and completeness of coding and abstracting. Successful completion of a coding certificate program, with American Health Information Management Association (AHIMA) approval status, as RHIA, RHIT, CCS or CCA is required.
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Title: RCM Specialty Follow Up Specialist – Workers CompDepartment: Central Business OfficeLocation: Security Park – B27 | On-siteThe RCM Specialty Follow Up Specialist for Workers Comp ensures accurate and timely submission of insurance claims, obtaining missing information, researching denials and documentation, following up on claims, and maintaining compliance with department standards, HIPAA, and governing agency policies and procedures.
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Under the direction of the Outpatient Audit, Analytics & Technology Supervisor, in conjunction with OP Audit Analysts and Coordinators will utilize documentation and coding expertise to facilitate audits of the quality and completeness of medical record documentation for outpatient encounters, including but not limited to clinic visits, outpatient surgical procedures, telemedicine, and other ancillary services.
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As a Benefit Relationship Manager (BRM), you will captain the strategic documentation and deployment of our clients' prescription benefit plan designs. Proven benefits coding operations experience in AS400 *Education.
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Masters use of clinical systems to ensure efficient and excellent supportive documentation, appropriate and optimal coding levels, charge capture, and follow-through on all patient care orders.
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This includes insurance verification, preparing patient accounts for billing, conducting accurate and timely follow-up, resolving patient and insurance company questions with regard to those bills, and ensuring receipt and documentation of all payments received.
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Supports other key objectives to drive capture of correct Risk Adjustment coding including documentation improvement, provider education, analyzing reports, and identifying process improvements.
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