Job Description

Specific Duties & Responsibilities

Procedural Knowledge

Responsible for all aspects of coding, quality assurance and compliance with Federal payer documentation guidelines.
Works closely with Office of Compliance for Professional Fee Services to include review of documentation.
Serves as departmental expert on coding questions.
Exercises independent judgment and decision making on a regular basis with respect to code selection.
Holds bills and seeks corrective action for services not meeting documentation requirements in accordance with Department policies.
Researches and answers billing and documentation questions or problems submitted by faculty, department, billing staff, and others to ensure compliance with specific payer regulations and CPA policies and procedures.
Supports department compliance efforts through participation in department training and education programs relative to specific product lines in accordance with established policies.
Conducts feedback/training sessions for physicians to present the results of medical record documentation as warranted.
Gathers and verifies all information required to produce a clean claim including special billing procedures that may be defined by a payer or contract.
Maintains a system of billing accuracy through encounter verification i.e., clinic schedules, encounter forms, I/P consults, medical records.
Review and resolve Epic Charge Review edits daily.
Pro Fee Tracking Database- May fill out missing information form and forward to the appropriate contact person.


Professional & Personal Development

Participate in on-going educational activities.
Keep current of industry changes by reading assigned material on work related topics.
Complete three days of training annually.


Service Excellence

Must adhere to Service Excellence Standards.
Customer Relations
Self-Management
Teamwork
Communications
Ownership/Accountability
Continuous Performance Improvement


Minimum Qualifications
High school diploma or graduation equivalent.
Medical Terminology, Anatomy and Physiology courses or demonstrated appropriate knowledge.
CPC Certification (or department approved certification).
Three years coding experience with demonstrated analytical skills.
Experience with Medicare regulations.
Additional education may substitute for required experience, and additional related experience may substitute for required education beyond a high school diploma/graduation equivalent, to the extent permitted by the JHU equivalency formula.


Preferred Qualifications
Epic experience.
Understanding of third party payer issues.