Job Description

The Senior Certified Coding Integrity Professional is responsible for all aspects of the coding and billing of all inpatient and outpatient claims, as well as all aspects of the CCM billing. The Senior Certified Coding Integrity Professional, a key position in the Revenue Cycle, facilitates the coding as well as manages the claims process, including accurate and timely claim creation, follow-up and correspondence with providers, insurance inquiries and patients related to coding issues. The incumbent will assist in the clarification and development of process improvements and inquiries in order to maximize revenues and will have an onsite presence at the clinical locations.

Requirements

ESSENTIAL JOB DUTIES and FUNCTIONS

While living and demonstrating our Core Values, the Senior Certified Coding Integrity Professional will:

• Perform accurate and timely multi-specialty coding for daily claims submission.
• Prepare and submit clean claims to third-party payers working closely with clinical team members regarding claims appeal, denial, and resolution.
• Perform audits of the daily billing summary reviewing the quality of the clinical documentation and coded data to validate that the documentation supports services rendered while ensuring the integrity of the coding.
• Respond timely (either orally or written) to account inquiries from patients, third-party payers, clinical providers, and/or other staff on claims submission.
• Interact with physicians, learners and other patient care providers on daily basis regarding billing and documentation policies, procedures, and regulations to ensure receipt and analysis of all charges; obtains clarification of conflicting, ambiguous, or non-specific documentation; as well as develop working relationship with operational leaders.
• Perform and monitor all steps in the billing and coding process to ensure maximum reimbursement from patients, third-party payers as well as from special billing arrangements.
• Assist in provider and learner education to ensure coding quality. Must have capacity to attend meetings day/evening as needed within assigned areas.
• Participate in clinical huddles/didactics and other clinical meetings as requested.
• Assist in the implementation and maintenance of the billing and coding educational materials used in clinical provider and learner training.
• Assist in the implementation and maintenance of population management learner training program addressing inpatient/outpatient chart review.
• Serve as a resource and subject matter expert for all billing and coding matters.
• Understand all aspects of Federally Qualified Health Center (FQHC) coverage, coding, billing and reimbursement of patient services, as well as other third-party payers.
• Understand Medicare, Medicaid and other commercial payer rules and regulations applicable to billing/coding.
• Understand the considerations of coding in Value Based payment contracts.
• Responsible for reviewing and implementing changes from payor bulletins.
• Follow coding/billing guidelines and legal requirements to ensure compliance with federal and state regulations.
• Serve as a coach and mentor for billing team & education team.

REQUIRED QUALIFICATIONS

• Bachelor or Associate degree in any Healthcare related field or equivalent experience.
• Must be a Certified Professional Coder with 7-10 years minimum direct professional coding experience. Certified Professional Coder CPC, Certified Risk Adjustment Coder CRC (not required but a plus), Certified Professional Compliance Officer Certification – CPCO (not required but a plus).
• Must have strong knowledge of all guidelines for ICD-10, CPT/HCPCS codes, medical terminology, and billing processes.
• Knowledge of Medical Billing/EHR (Electronic Health Records) systems preferably Medent.
• Knowledge of EOBs (Explanation of Benefit), EFTs (Electronic Funds Transfer) and ERAs (Electronic Remittance Advice).
• Knowledge of Microsoft Office software.
• Must possess team leadership skills and have a positive disposition.
• Must be focused, self-directed, & organized, with problem-solving abilities.
• Accurate and precise attention to detail.
• Excellent verbal and written communication skills.

REQUIRED LICENSES/CERTIFICATIONS

• Certified Professional Coder-CPC
• Certified Risk Adjustment Coder-CRC (not required but a plus)
• Certified Professional Compliance Officer Certification – CPCO (not required but a plus)

PREFERRED QUALIFICATIONS

• FQHC billing helpful (not required but a plus).
• General working knowledge/previous exposure of healthcare environments and auditing concepts, medical billing/operations, medical terminology and clinical documentation.