Revenue Integrity Coder

Description

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Summary :

The Revenue Integrity Coder is responsible for determining charges for outpatient departments of the hospital, inpatient, split bill and hybrid clinics. Also responsible for Pardee Urgent Care charges and coding. Works collaboratively with members of Patient Financial Services, Billing Office, clinical and other departments to ensure timely revenue capture.

Responsibilities :

• Maintains a thorough understanding of hospital outpatient and physician billing requirements. Maintains understanding of RVU's (Relative Value Units) which are assigned to each HCPCS or CPT code. Maintains understanding of modifiers required for professional and hospital coding. Participates in continuing education opportunities to understand charging and coding changes and updates.
• Interprets usage of HCPCS and CPT codes, including research of NDC and NCCI review for compliant billing when clearing work queues. Assigns and verifies accurate use of modifiers when clearing work queues. Follows work schedule on Revenue Integrity work flow calendars.
• Ensures compliance with federal and state rules by reviewing CMS (Center for Medicare Services) and Palmetto GBA (MAC) daily transmittals for any changes or new issues regarding charge and coding and patient charge rules.
• Reviews Urgent Care, Workers Comp and occupational medicine encounters for the Pardee Urgent Care Centers. Verifies documentation , reviews E&M level charged, an procedures performed and medications administered. Also verifies diagnosis codes on encounter. Queries providers or other appropriate staff when documentation is in question or orders are not matching documentation.
• Reviews Emergency and Observation patient charts in detail to capture all charges and verify hours charged on a daily basis. Reviews Outpatient Ambulatory, OB Triage ad Extended Recovery patient charges on a daily basis. Reviews documentation and determines charges for split bill clinics for both technical and professional billing on a daily basis; reviews diagnosis for accuracy. Reviews all work queues assigned to Revenue Integrity and clears the accounts accurately and on a daily basis. Keys in corrections to patient accounts based on Department Director requests and patient account error analysis through Epic. Reviews coding and charging edits received, which may include contacting the physician for additional documentation, diagnosis or symptoms as needed. Assists the billing office and HIM to resolve billing issues and denials that are coding and CPT / HCPCS related.

Other information : Required

Preferred

CRICC Certification

Job Details

Legal Employer : Pardee - HCHC

Entity : Pardee UNC Health Care

Organization Unit : Health Information Management

Work Type : Full Time

Standard Hours Per Week : 40.00

Work Assignment Type : Onsite

Work Schedule : Day Job

Location of Job : PARDEEHOSP

Exempt From Overtime : Exempt : No

Qualified applicants will be considered without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, genetic information, disability, status as a protected veteran or political affiliation.