Responsible for diagnosis and CPT coding within the various department-billing offices. Will review or code charges for diagnosis and CPT for entry into the JHM and JHU/ PBS billing applications. This can be accomplished through an interface or manual charge entry for services performed at JHM practice sites.
Specific Duties & Responsibilities
Gathers and verifies all information required to produce a clean claim including special billing procedures that may be defined by a payer or contract.
Bundle appropriately for CPT and payer guidelines.
Verify location of codes for appropriateness.
Verify provider type i.e., level 1, 2, etc according to visit and procedure.
Responsible for maintaining a system of billing accuracy through encounter verification i.e., clinic schedules, encounter information in EPIC, I/P consults and medical records.
Follows payer guidelines.
Follows limiting coverage guidelines for diagnosis coding by using LCD/NCD/payer policy information and assigns appropriate modifiers based on departmental policy
Carries coding out to fourth or fifth digit as appropriate.
Follows ICD-10 codes to ensure diagnosis codes are appropriate for each specialty.
Review and resolve EPIC Charge Review edits daily.
May obtain correct NPI number and all needed information for Referring Doc Dictionary.
May act as a back up to Charge Entry when needed.
Pro Fee Tracking Database- May fill out missing information form and forward to the appropriate contact person.
Exercises independent judgment in daily activities. Technical Knowledge:
Comprehensive knowledge and compliance of HIPAA rules and regulations in the dissemination of patient Protected Health Information (PHI).
Working knowledge of JHU/ PBS Billing Applications.
Utilize online resources to facilitate efficient claims processing. Professional & Personal Development:
Participate in on-going educational activities.
Assist in the training of staff.
Keep current of industry changes by reading assigned material on work related topics.
Complete three days of training annually.
Must adhere to Service Excellence Standards.
Continuous Performance Improvement
High School Diploma or GED.
Minimum one (1) year related experience in medical billing and demonstrated analytical skills.
Medical Terminology, Anatomy, and Physiology courses or demonstrated appropriate knowledge.
Understanding of third party payer issues.
Special Knowledge, Skills, and Abilities
Able to operate basic office equipment, e.g. photocopier, fax machine, scanner, PC, telephone, etc.
Classified Title: Coding Specialist Working Title: Coding Specialist Role/Level/Range: ATO 40/E/02/OE Starting Hourly Pay Rate Range: $17.42 - $23.95 /Commensurate with Experience Employee group: Full Time Schedule: Monday - Friday, 8:30a.m - 5:00p.m / 40 hours per week Exempt Status: Non-Exempt Location: 16-MD:JH at White Marsh Department name: 10003283-SOM Rad Onc General Administration Personnel area: School of Medicine
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