Central Health

  • Claims Review Specialist

    Req No.
    2018-3214
    Company
    CommUnityCare Health Centers
    Name
    Kramer
    Address
    2115 Kramer Lane, Suite 100
    City
    Austin
    Category
    Administrative
    State
    TX
    Type
    Regular Full-Time
    Shift Days
    M-F
    Shift Hours
    8am to 5pm
  • Overview

    In collaboration with patients, families (as defined by the patient) and staff across all disciplines and departments is responsible for monitoring billing and accurately coding procedures in support of the goals of the organization and in compliance with all applicable regulations. 

    Responsibilities

    PRIMARY RESPONSIBILITIES & DUTIES

    • Conduct chart audits on documentation and correct coding to ensure compliance with all governmental and contractual obligations.
    • Compile audit findings to present to leadership.
    • Identifies trends and issues in coding or systems and notifies leadership.
    • Review patient encounters for proper use of procedure codes/modifiers and diagnosis codes.
    • Utilize CPT, ICD-10, HCPCS and CMS manuals to ensure accurate documentation and coding.
    • Assist in development of documentation and coding education programs for clinical staff.
    • Train providers in proper documentation and coding as indicated by chart review.
    • Assist with process improvement to maximize reimbursement. 
    • Adheres to policies, procedures and regulations to ensure compliance and patient safety.
    • Perform other duties as assigned.

    PRIMARY ACCOUNTABILITIES

    • Maintain compliance with all applicable federal and insurance regulations.
    • Ensure that all department and organization deadlines and goals are met.
    • Ensure that all work is done in a timely and accurate manner.
    • Maintain up-to-date knowledge of billing and coding programs.
    • Maintain continuing education for certification requirements.
    • Develop and maintain effective working relationships with providers and co-workers
    • Ensure all actions, job performance, personal conduct and communications represent CommUnityCare in a highly professional manner.
    • Uphold and ensure compliance and attention to all company policies and procedures as well as the overall mission and values of the organization.

    ESSENTIAL FUNCTIONS/ KEY COMPETENCIES

    • High level of skill at building relationships within the organization.
    • Ability to utilize computers for data entry and information retrieval.
    • Strong attention to detail and accuracy.
    • Excellent verbal and written communication skills.

    Qualifications

    POSITION REQUIREMENTS

     

    Education

    • High school diploma or equivalent.
    • CERTIFICATION: Must be one of the following:
      • Certified Coding Specialist (CCS) through governing body AHIMA
      • Certified Coding Specialist - Physician (CCS-P) through governing body AHIMA
      • Certified Professional Coder - (CPC) through governing body AAPC
      • Certified Professional Coder - Hospital (CPC-H) through governing body AAPC

     

    Knowledge and Experience

    • Minimum of 1 year experience in medical coding or medical auditing.
    • Demonstrated knowledge of policies, procedures/rules, and regulations used in interpreting proper billing and coding processes and techniques.
    • Demonstrated knowledge of ICD-10, CPT and HCPCS coding.
    • Demonstrated knowledge of medical terminology, anatomy, and insurance processes.
    • Demonstrated proficiency in the use of computer and commonly used software including but not limited to Microsoft Office Suite.
    • Experience with NextGen PM/EMR system preferred.

     Physical/ Environmental

    • Constant sitting, standing and walking.
    • Constant use of a computer.
    • A medium to high level of manual dexterity required.

    Options

    Sorry the Share function is not working properly at this moment. Please refresh the page and try again later.
    Share on your newsfeed