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About the Role
This position is responsible for coding conditions and procedures using the appropriate classification system and managing patient and/or relative interactions regarding non-medical aspects of hospitalization related to payment for care and treatment. The role involves maintaining cooperative relationships with patients and families and facilitating payment for hospital care and services, with considerable independence in handling individual patient situations under established policies.
Responsibilities
- Codes and submits claims, ensuring accuracy and correct sequencing according to regulations.
- Follows up with providers on insufficient or unclear documentation.
- Communicates with clerical staff regarding documentation.
- Searches for information in complex or unusual coding cases.
- Reviews patient notes for evaluation and coding.
- Ensures all codes are current and active.
- Contacts self-pay patients during hospitalization to discuss costs, billing, and financial arrangements.
- Arranges payment by self-pay patients according to guidelines.
- Advises patients and families on available financial benefits and resources.
- Collects on delinquent accounts by establishing payment arrangements, monitoring payments, and following up on lapses.
- Submits claims electronically and/or paper to insurance carriers for primary and secondary claims.
- Accesses internet websites to determine claim eligibility, third-party regulations, and updates.
- Contacts third-party payers for non-payment and follows up on claim rejections, submitting corrected claims.
- Contacts insurance carriers, employers, and governmental agencies to verify insurance coverage or benefit eligibility.
- Works with the Department of Social Services to report spend-down balances and Medicaid application status.
- Performs documentation and follow-up for incorrect or denied payments.
- Receives patient payments, records them, and reconciles patient accounts.
- Reconciles aged patient and insurance accounts and follows up on outstanding balances.
- Checks final bills for accuracy and bills patients, maintaining electronic records.
- Refers delinquent accounts to collection agencies and reconciles related reports and payments.
- Offers and applies charity care assistance according to guidelines.
- Maintains Personal Incident Accounts (PIA) for nursing home residents.
- Sorts and files correspondence, answers phones, writes appeal letters, photocopies, handles daily mail, and orders office supplies.
- Maintains quality results by following standards.
- Maintains work operations by following policies and procedures and reporting compliance issues.
- Reports patient care or billing complaints to the compliance officer.
Requirements
- Graduation from high school or possession of an equivalency diploma.
- Certification through AHIMA or AAPC and one year of clinic coding experience; OR
- Two years of full-time paid experience in medical records preparation and maintenance in a healthcare setting, involving coding and indexing, filing and maintenance, analysis and evaluation, and electronic health records use; OR
- An equivalent combination of training and experience.
Skills
- Office terminology, procedures, and equipment
- Official coding guidelines
- Business arithmetic
- Medical record coding
- Oral and written instructions comprehension
- Personal computer operation
- Common office software programs
- Clerical ability
- Cooperative relationship building
- High level of accuracy
- Understanding and application of legal concepts regarding confidentiality and compliance
Experience Level
- One year clinic coding experience (with certification)
- Two years of full-time paid experience in medical records preparation and maintenance (with specific duties)
Education Level
- High school diploma or equivalency
- Certification through AHIMA or AAPC
Salary/Compensations
- $22.29—$28.45 USD