Under general supervision, collects data by abstracting, assessing and analyzing demographic and clinical information. Spends greater than 50% of each day coding (CPT, HCPCS and ICD-10) each new chemotherapy and infusion therapy regimen to ensure compliance with FDA and NCCN guidelines. Provides correct diagnosis and procedure codes to authorization staff to ensure insurance approval of services. Audits daily infusion therapy charges and educates nursing staff as appropriate. Routinely audits and educates physicians regarding evaluation and management, ICD-10 coding and documentation requirements. Works assigned work queues in EPIC to correct coding, claims and insurance discrepancies. Corrects ICD-10 coding errors for labs/procedures using local and national coverage determinations and educates providers if necessary. Manages denials and appeals to the insurance company as appropriate. Meets with patients and families to discuss financial requirements and insurance benefits regarding chemotherapy and infusion therapy. Assists patients in applying for financial assistance. Assists authorization department with denials and arranges peer to peer review. Under limited supervision, is responsible for the day-to-day collection of past due accounts. Responsible for ensuring that front office personnel understand and follow the billing requirements of various insurance carriers. Monitors deposits daily. Fields all calls regarding billing and coding from patients, providers and insurance companies. Has an understanding of global billing and educates providers and patients?
Specialized training in coding/abstracting procedures, anatomy and physiology, and medical terminology. AAPC or AHIMA coding certification required.
2 years of progressive medical billing experience to include customer service; 1 year of CPT and ICD-9/ICD-10 coding experience with accreditation.
- Knowledge of anatomy and physiology, medical terminology, and ICD-9/ICD-10 and CPT coding
- Skill in written and oral communication
- Skill in using computers and personal productivity applications
- Knowledge and understanding of third party insurers
- Skill in using effective customer service techniques
- Skill in data research, analysis and interpretation
- Accreditation by AAPC or AHIMA
- Ability to sit, stand, walk, concentrate and pay close attention to detail
- Normal office environment with little exposure to excessive noise, dust, temperature, and the like.