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HealthCore Clinic Certified Coding and Auditing Specialist in Wichita, Kansas

This job was posted by https://www.kansasworks.com : For more information, please see: https://www.kansasworks.com/jobs/12318733


The Coding and Auditing Specialist is responsible for reviewing, coding and auditing of documentation for all patient encounters as well as provide training and education to providers and staff. This position also accurately code office procedures for providers to ensure proper reimbursement. This position also reviews coding edits and denials and makes appropriate changes to claim.


+ High School diploma or GED

+ Certified Professional Coding Certification (CPC) or equivalent.

+ Prefer 1-3 years of experience in professional medical coding.

+ Computer competency; experience with EMR, revenue cycle systems, data entry and Excel

+ Strong basic arithmetic skills to make calculations, balance and reconcile figures and make changes accurately.

+ Excellent written and verbal communication skills both interpersonal and professional, good listening skills and pleasant, respectful telephone etiquette.

+ Excellent organizational skill, attention to detail and time management skills.

+ Knowledge of:

+ Federal laws and payer regulations affecting coding requirements.

+ ICD-10-CM, CPT and HCPCS guidelines and practices.

+ E/M Coding requirements.

+ Billing practices required.

+ FQHC billing knowledge is helpful

Essential Functions:

+ Comply with all legal requirements regarding coding procedures and practices

+ Accurately assign ICD-10-CM, HCPCS and CPT codes on encounters

+ Review coding edits and denials. Make appropriate corrections for filing claim.

+ Review pending claims and additional denials for correction and refiling.

+ Collaborate with the billing specialists to ensure all bills are satisfied in a timely manner.

+ Communicate with insurance companies about coding errors and disputes.

+ Perform financial clearance of patient accounts by verifying insurance eligibility and benefits and ensuring all notifications and authorizations are completed within the required timeframe.

+ Completes appropriate payor forms related to notification and authorization.

+ Coordinates the submission of clinical documentation from physicians to payers for authorization needs.

+ Coordinate with Coding auditor on conducting audits and coding reviews to ensure all documentation is accurate.

+ Contact providers with questions regarding treatments and diagnostic test to ensure coding accuracy and services billed accurately reflects the care and treatment rendered.

+ Calculates accurate patient financial responsibility.

+ Communicates timely with Utilization Review, and collaborates effectively with physician and facility staff to ensure financial clearance of the patient's account prior to scheduled or unscheduled service during the patient's visit.

+ Interprets complex payer coverage information including, but not limited to, network participation status with provider, limited plan coverage and inactive benefits.

+ Documents systems according to the Insurance Verification guidelines to assure accurate and timely reimbursement.

+ Ability to understand and adhere to payer guidelines by plan and service type.

+ Ability to communicate effectively with vulnerable populations including those made vulnerable by their financial status, personality characteristics, place of residence, health status and/or age.

+ Ability to maintain a professional demeanor in a highly stressful and emotional environment, behavioral health and/or suffering patients in addition to lif e or death situations.

+ Must be able to exhibit a high level of empathy with the ability to effectively communicate with patients and family members during traumatic events, while demonstrating exceptional customer service skills.

+ Ability to compose and generate documents and reports.

+ Ability to manage multiple, changing priorities in an effective and organized manner.

+ Communicates regularly with all staff members and participates in regular departmental meetings.

+ Attends and participates as a team member on at least one HCC quality team initiative team such as quality improvement, safety, and/or employee recognition teams.

+ Performs other related duties, which may be inclusive, but not listed in the job description