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Supports the integration of new physicians/practice(s) into the PBO by providing professional charges by CPT code to PeC for dictionary modifications; assisting in the orientation/training of practice staff (coordinating with credentialing staff, Cadence, Ambulatory, Patient Service Center, Partners PeCare team.
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Works collaboratively with Patient Financial Services, PBO Registration, Patient Service Center, PBO Coding, Payer Relations and their counterparts on the Hospital Revenue Integrity Team to insure efficient processing and follow up on all professional revenue.
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Capable of performing all aspects of medical billing and coding including but not limited to charge entry, posting insurance payments, rejections, follow up, and prior authorizations. Experience in CPT and ICD-10 coding.
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Responsibilities include; stewardship of Patient Billing and Collection, A/R Management, Application Systems Support, Claims Management, Coding, Charge Capture, Data Entry, Account Follow-Up, Customer Service, Denial Management, Edit Management, Payment Variance Analysis, Contract Analysis, Credit Analysis, Refund Management, Payment Posting, Auditing, Training, and Productivity and Performance Reports.
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Job DescriptionJob DescriptionJob DescriptionThe Professional Coding Auditor performs reviews for professional/clinic based clinic visits and hospital setting claims reviewing providers diagnosis and procedural coded claims in ensuring coded data is in compliance with Official Coding Guidelines and American Medical Association CPT/HCPCS procedural coding conventions.
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Payment Posting; Processing Claims; Charge Entry; AR Follow-up’ Insurance Verification. Responsible for review clinical documentation to abstract and/or validate CPT and ICD-10 coding medical services.
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Follow-up with patient as appropriate to ensure compliance with recommendations, medications, lab/x-ray results, special visits, PCP visits, dieticians, diabetes educators, etc. CPT - Phlebotomy Technician Certification.
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The notes recorded in Veeva should be limited to basic information for follow up calls (i.e., diagnosis codes, CPT codes, reason for denial) and office contact logistics. Experience as a Reimbursement Access Manager - RAM or Field Reimbursement Manager - FRM.
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Strong working knowledge of ICD-10, CPT, HCPCS, referrals and pre-certification procedures, as well as documentation guidelines. Ability to read and interpret LCD/NCD requirements in regard to CPT and HCPCS denials.
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Responsibilities include coordinating surgical procedures with Operating Room, scheduling, and obtaining pre-operative testing, writing, and communicating surgery orders including ICD-10 and CPT codes, obtaining clearances from requested specialties, guiding patients through the surgical process and collecting necessary documentation for surgeries, scheduling recommendations from consultations including imaging, follow-ups, and lab work.
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CCMA - National Certified Clinical Medical Assistant (NHA) OR. High School diploma or equivalent education (examples include: GED, verification of homeschool equivalency, partial or full completion of post-secondary education, etc.
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Knowledge of ICD-9 and CPT coding and basic computer skills. Maintains accurate testing, referral and appointment logs with follow-up verification in the referral tracking database. Specialties include cardiology, cardiothoracic surgery, cardiovascular surgery, endocrinology, gastroenterology, general surgery, infectious disease, neurology, neurosurgery, obstetrics and gynecology, occupational medicine, orthopedic surgery, physical medicine and rehabilitation, primary care, pulmonology, reproductive medicine, rheumatology, sleep medicine and urology.
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Understanding of all or a combination of ICD-9, ICD-10, CPT, HCPCS, medical terminology and HIPAA Compliance. Collaborate with Client Services Manager to maintain and follow up on client issues log, participate in client conference calls / meetings and develop work strategy.
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Candidate is preferred to be a Certified Professional Coder who can review patient records to ensure the accuracy of coding and billing compliance of ICD-10 and CPT Codes for claim scrubbing with ease.
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CCMA - National Certified Clinical Medical Assistant (NHA) RMA - Registered Medical Assistant (AMT) This position also performs general administrative duties in accordance with CLIA, HIPAA, NCQA and government standards, as well as company policies and procedures.
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