Certified Medical Coder and Biller

Position Summary

Under general supervision from Director of Finance, works closely with the physicians to review diagnosis and procedural codes to medical procedures to ensure compliant coding/billing of facility and office based services for OB/GYN, including office visits, deliveries, surgeries, circumcisions and hospital triage. Monitors and reviews all medical records in order to assure the accuracy of medical coding, including appropriate completion and documentation of physician signatures, and proper coding of all diagnoses and procedures. All billing is submitted through EPIC. Thorough understanding of CMS/Medicare regulations, as well as technical knowledge of the International Classification of Disease (ICD-10) and Current Procedural Terminology (CPT-4 classification systems. Promptly notifies physicians of missing information and follows up accordingly. May provide administrative, corrections and data entry support as required.

Essential Functions

• • • Correctly enters coding information into an EPIC electronic medical record system.
    • Serves as a resource on E/M coding issues to the OB/GYN providers.
    • Assists with the development of processes and procedures structured to optimize reimbursement, limit liability and enhance data integrity.
    • Keeps up to date on billing/coding rules, including the annual update of CPT-4 and ICD-10 codes.
    • Maintains CEUS needed for certification.
    • Performs all job functions in compliance with applicable federal, state, local and company policies and procedures.
    • Runs daily eligibility checks and confers with front desk staff to correct and obtain patient information.
    • Ensures that CPT and ICD-10 codes are aligned so that there will be no question as to the relationship between diagnosis and treatment and the claim will be reimbursed. * * Contact payers as needed to research unposted or denied payments.
    • Completes all necessary research to provide patient and/or physician with clear and accurate account information.
    • Communicates effectively and respectfully with all internal and external customers.
    • Answer incoming phone calls from patients, third party vendors and internal customer and assist with customer service issues.
    • Respond to customer concerns in a courteous and timely manner.
    • Make any necessary system corrections to the patients account.

Non-Essential Functions

• • • Performs other duties as needed. Any other duties performed which are not listed as essential functions are considered non-essential functions.
    • Reviews OB/GYN patient medical records and abstracts medical data to accurately capture all diagnoses, procedures, and appropriate modifiers from the medical record documentation using ICD-10-CM, CPT4/HCPCS classification systems.
    • Evaluates medical documentation and determines accurate E/M levels for both office and hospital records.
    • Ensures that professional services are captured and coded in compliance with federal regulations and insurance requirements.
    • Assesses encounter documentation using Center for Medicare and Medicaid Services (CMS) documentation standards.
    • Based on the provider’s documentation identifies possible documentation changes which, if implemented, would more accurately account for services provided. Presents findings to the provider and works to resolve issues.

Minimum Requirements.

• • • Education: High school graduate or equivalent.
    • Certification in medical billing required.
    • 2-4-year degree in healthcare or related field preferred.
    • OB/GYN experience highly preferred.
    • EPIC experience highly preferred.

Skills and Experience

• • • At least 5 years recent coding experience, experience coding OB/GYN and surgical cases preferred.
    • Must be experienced in E/M leveling and coding for both office/hospital professional coding.
    • Thorough knowledge of medical terminology, ICD-10-CM and CPT4 coding necessary.
    • Understanding of both the medical and business side of healthcare operations.
    • Highly organized, self-motivated, detail-oriented and energetic team player.
    • Ability to multi-task in a fast-paced environment.
    • Excellent verbal and written communication skills.
    • Must be detail oriented.
    • Strong computer skills including MSOffice, Internet, and E-mail.
    • Excellent problem solving ability and good interpersonal skills.
    • Experience with EPIC is highly preferred.

Excellent Benefits Include:

• • • Competitive health benefit package
    • Dental and Vision Insurance
    • Paid Time Off
    • 401 (K) Plan with Employer Contribution
    • Disability Insurance (Short and Long term)
    • Life Insurance

Job Type:

Full-time

Only qualified candidates need apply. A cover letter is required with your application for your application to be considered.

Vaccines

As a health care organization, we have a responsibility to do everything in our power to care for and protect our patients, our colleagues and our communities. Essex County OB/GYN requires that all staff be vaccinated against COVID-19 as a condition of employment.

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