Job Description

Under direct supervision of the Revenue Cycle Manager, this position reviews and resolves coding issues related to billing; researches coding issues and participates in process improvements related to coding and AR management. This position may also provide education to providers and staff on correct documentation, coding, and billing of medical claims.

• Work with accuracy and ensure changes are within the scope of the policies.
• Check that claims are passing internal edits in a timely fashion.
• Ensure that denied claims, are corrected or appealed in a timely manner.
• Provide appropriate feedback to management.

Key Responsibilities

• Determine that appropriate information is submitted to insurance companies.
• Ensure that the actions taken on denied claims are paid on the first follow-up call or appeal.
• Maintains up to date knowledge of billing and reimbursement.
• Identify and communicate AR trends and denial issues impacting AR or daily production
• Ability to meet productivity and accuracy standards.
• Request appropriate adjustments based on contract, modifiers or appeal denials.
• Works to understand the procedures billed in OP notes or bundling issues to maximize the value of submitted appeals.
• Utilizes the coding resources (CPT, ICD-10, AAOS books, Decision Health and Select Coder) to understand denied procedures.
• Corrects accounts that are billed incorrectly in the PM.
• Helps the Revenue Cycle Specialists understand and complete their correction requests.
• Assure compliance with all company plans, policies and procedures set forth by Orthopaedic Solutions Management
• All other duties as assigned.

Qualifications:

• High School Diploma or general education degree (GED)
• CPC, CPC-A, RHIT or CCS Certification required.
• 2 – 4 years of experence.
• Knowledge of ICD10, CPT HCPCS and the use of modifiers preferred.
• Surgical coding experience preferred.
• Knowledge of Medicare Part B and commercial insurance products and plans.
• Familiar with CMS 1500 completion preferred.
• Advanced understanding of medical terminology and anatomy.
• Familiar with NCCI guidelines.
• Athena experience preferred.
• Excellent communication skills both written and verbal.
• Must be detail oriented and a self-starter
• Requires comprehensive knowledge of computer skills including Microsoft Office Suite
• Comfortable in a fast-paced working environment of a growing practice.

Orthopaedic Solutions Management is a Drug Free Workplace

We are committed to maintaining a safe, healthy, and productive work environment. As part of this commitment, we operate as a drug-free workplace. All candidates will be required to undergo pre-employment drug screening and/or be subject to random drug testing in accordance with applicable laws and company policy.