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Communicate and collaborate with medical coding team regarding risk adjustment projects. Support activities to identify risk adjustment strategies and tactics, and then to implement the activity sets (Medicare, Medicaid, Exchange, and Commercial.
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Background in ICD9 and CPT coding and all insurance plan types (HMO, PPO, Managed Care, Medicare, Medicaid, and commercial insurances). Manages, coordinates, and directs all aspects of medical offices for the medical clinic including all business office operations I.T., patient scheduling, records, billing, communications, personnel administration, material control, including OSHA, CLIA and other regulatory criteria, and all other related activities to meet practice objectives.
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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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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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Working knowledge of Medicare/Medical billing/coding processes and understanding of Medical and Research billing and coding utilizing CPT, ICD-10 and HCPCS. Certified Coding Specialist certification preferred but not required.
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Acts as an advisor and consultant in the establishment of operational policies of the practice to include: (1) Purchasing and capital allocations; (2) Managed care plan participation; (3) Budget and practice expenses; (4) Medicare/Medicaid participation; (5) Billing and collection of professional fees; (6) Personnel management and related policies; (7) Risk management and quality assurance; and (8) Coding compliance.
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Certification: Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT) or Certified Professional Coder (CPC) certification or Certified Coding Specialist (CCS.
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Conceptual and practical knowledge of health data (e.g. commercial, Medicare, Medicaid, or APCD claims data; EHR and/or HIE data; healthcare informatics; medical coding). Conceptual and practical knowledge of health data (e.g. commercial, Medicare, Medicaid, or APCD claims data; EHR and/or HIE data; healthcare informatics; medical coding.
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This job will deliver value to the Health Plan, and its beneficiaries enrolled in Risk Adjusted government programs such as Medicare Advantage (MA) and Affordable Care Act (ACA), using skills including but not limited to Hierarchical Condition Category (HCC) Coding, medical coding, clinical terminology and anatomy/physiology, Centers for Medicare and Medicaid Services (CMS) coding guidelines, and Risk Adjustment Data Validation (RADV) Audits.
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Job Responsibilities:Reviews medical record documentation and accurately assigns appropriate ICD-10 diagnoses and procedure codes, leading to the assignment of the correct Medicare Severity-Diagnosis Related Group, (MS-DRG) or All Patient Refined Diagnosis Related Group, (APR-DRG.) The Inpatient Coding Specialist is responsible for verification of the patient's discharge disposition and to ensure the appropriate present on admission, (POA) indicators are assigned to each code.
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Apply coding knowledge to analyze/correct CCI Edits and Medical Necessity Edits. Identify appropriate assignment of CPT and ICD-10 Codes for outpatient Acute Interventional Radiology services while adhering to the official coding guidelines and established client coding guidelines of the assigned facility.
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Job Highlights: Additional Job DescriptionThe incoming Cardiologist will be an employee of SSM Health Medical Group’s Heart & Vascular Care. This physician will join an experienced and collegial group of cardiologists and mid-level practitioners in the South St. Louis County, MO, market.
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Medical Billing Assistant is responsible for handling all types of insurance claims, including private, Medicare and Medicaid. Working knowledge of coding & billing functions of third party payer system, including Medicare, Medicaid, and commercial insurance.
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Minimum 3-5 years progressive experience in a medical office with at least 2-3 years as medical clinic manager. UT Health East Texas Physicians has over 90 primary and specialty care clinics, providing comprehensive medical education and innovative research.
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Maintain knowledge of current laws and regulations related to insurance, Medicare, Medicaid, and DRG coding, sequencing, and CPT coding. Job SummaryThe Medical Coder is responsible for ICD-10 coding of diagnoses and procedures of inpatient/outpatient Emergency Room discharged patient records.
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