About this role
Role Overview
- Monitor, review and apply correct coding principles to clinical information received from ambulatory areas for the purpose of reimbursement, research and compliance.
- Identify and apply diagnosis codes, CPT codes and modifiers as appropriately supported by the medical record in accordance with federal regulations.
- Ensure that billing discrepancies are held and corrected.
- Compare and reconcile daily patient schedules/census/registration to billing and medical records documentation for accurate charge submission, which includes (but not limited to) processing of professional charges, facility charges and manual data entry.
- Maintain records to be used for reconciliation and charge follow up.
- Investigate and resolve charge errors.
- Meet coding deadlines to expedite the billing process and to facilitate data availability for CCF providers to ensure appropriate continuity of care.
- Manage professional held claims within the CCF claims processing system.
- Review, abstract and process services from surgical operative report.
- Review, communicate and process physician attestation forms.
- Communicate with physicians and other CCF departments (co-surgery) to resolve documentation discrepancies.
- Assist with Evaluation and Management (E&M) audits and other reimbursement reviews.
- Review and resolve E&M denials within the denial database.
- Capture appropriate charges in accordance with CMS billing rules and regulations.
Requirements
- High School Diploma / GED
- Specific training related to CPT procedural coding and ICD9 CM diagnostic coding through continuing education programs/ seminars and/or community college
- Knowledge of human anatomy and physiology, disease processes and demonstrated knowledge of medical terminology
- Three years of coding to include one year of complex coding experience in a health care environment and/or medical office setting
- Certified Coding Associate (CCA), Certified Coding Specialist (CCS), Certified Coding Specialist Physician (CCS-P), Registered Health Information Technologist (RHIT), Registered Health Information Administrator (RHIA) by American Health Information Management Association (AHIMA) or Certified Professional Coder (CPC) or Certified Outpatient Coder (COC) by American Academy of Professional Coders (AAPC)
- Proficiency in coding and claims editing
- Internal candidate: must currently be employed as a Professional Coder II at the Cleveland Clinic or have met all the training, quality and productivity benchmarks of a Professional Coder II
- Coding assessment relevant to the work may be required
Benefits
- We know that fully supporting our caregivers is what creates the best outcomes for our patients. Our outstanding, comprehensive offerings are an investment in your health, well-being and future.