Job Details

Summary:

Review, analyze, and code medical record documentation to include, but not limited to, medical, diagnostic and procedural information for the correct ICD-9 and/or ICD-10 and/or CPT-4 HCPCS codes to the greatest specificity. Abstracts demographic and coding information into the information system accurately and completely. Reviews documentation for medical necessity. Audits orders and claims before submission for entirety and accuracy and to minimize claim denials. Assesses records and prepares reports. Develops effective working relationships with physiciansand other stakeholders.

Project Details:

• Evaluate medical record documentation and charge ticket coding to optimize reimbursement by ensuring that diagnostic and procedural codes and other documentation accurately reflect and support the visit
• Compile necessary documentation prior to coding review; when documentation is not available, performs the appropriate steps to obtain the necessary documentation per the department's policies and procedures
• Ensure demographic information and documentation are congruent with scheduled or performed procedures
• Evaluate records and prepare reports of appropriate production metrics and coding feedback and maintain or exceed established productivity and coding accuracy standards
• May monitor unbilled accounts
• Query physicians when code assignments are not straightforward or documentation is inadequate, ambiguous, or unclear for coding purposes
• Offer physician opportunity to submit corrected documentation
• Notify appropriate individuals of potential non-compliance with medical necessity requirements and when services are non-covered or not payable, as appropriate
• Correct failed claim errors to billing edits, clinical trial codes, and other coding related errors
• Document coding information, and take appropriate actions in the Practice Management System in accordance with the department's policies and procedures
• Assign and sequences codes accurately based on medical record documentation
• Assign the appropriate discharge disposition as necessary
• Enter physician practice statistical and reporting requirements
• Track your own continuing education credits to maintain professional credentials
• Obtain demographic and insurance information
• Work assigned task lists and/or work queues
• May research the status of any third party payers through use of the appropriate systems
• Maintain up-to-date knowledge of third party payer reimbursements and managed care contracts
• Maintain knowledge and is familiarity with appropriate billing and accounts receivable systems
• May identify all components of an Explanation of Benefits/Explanation of Payments
• Perform other duties as assigned

Job Experience:

• High school diploma or equivalent required
• RHIA, RHIT, CPC, CPC-H, CCA, CCS-P, or equivalent coding certification required
• Coding Certificate program, AAPC or AHIMA accredited preferred
• Coding experience preferred
• Knowledge of ICD-9-CM/ICD-10-CM and CPT coding principles and guidelines
• Knowledge of medical terminology, abbreviations, techniques and surgical procedures; anatomy and physiology; major disease processes; pharmacology; and the metric system
• Knowledge of reimbursement systems, as well as federal, state and payer-specific regulations and policies pertaining to medical documentations, billing and coding
• Knowledge of Standards of Ethical Coding
• Advanced knowledge of third-party insurance in regards to plan types: HMO, PPO, POS, and Indemnity preferred
• Excellent knowledge of the Medicare Program particularly as it relates to CPT and ICD9 coding CPT preferred
• Thorough knowledge of Medicare Fraud and Abuse regulations preferred
• Skill and ability to communicate effectively both orally and in writing
• Skill and ability to research and analyze data, draw conclusions, and resolve issues
• Skill and ability to read, interpret, and apply policies, procedures, laws, and regulations; read and interpret medical procedures and terminology; develop training materials; make group presentations; exercise independent judgment; and prepare reports and related documents
• Skill and ability to maintain working relationships with physicians and other staff
• Skill and ability to review the work of others and maintain confidentiality

Hourly Rate: 25-33

Oxford is an Equal Employment Opportunity Employer. All qualified applications will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other characteristic protected by law. Oxford will consider qualified applicants with criminal histories in a manner consistent with the requirements of applicable law. Oxford provides supplemental medical (we do not offer major medical), dental, vision, life, and disability benefit plans along with a 401(k) Retirement Savings Plan. Paid holidays based on eligibility and paid sick leave for applicable jurisdiction, as required. Oxford is committed to working with and providing reasonable accommodation to individuals with physical and mental disabilities. If you need special assistance or an accommodation while seeking employment, please email ...@oxfordcorp.com . We will make a determination on your request for reasonable accommodation on a case-by-case basis.