Oklahoma Arthritis Center (OAC) is an Equal Employment Opportunity employer and considers all applicants without regard to race, religion, color, sex, national origin, age, disability, veteran status, or any other legally protected status.
Job Summary:
Reviews billing data from medical office or hospital records to ensure amounts and account numbers are accurate, responsible for account posting, collections, and verifying patient benefits. Responsible for accurate diagnose and procedure coding. Responsible for insurance pre-certifications, pre-authorizations, pre-determinations and other required insurance notifications for procedures performed in the clinic.
Essential Functions:
- Review and analyze patient records and physician documentation for completeness and accuracy, focusing on areas such as radiology reports, neurological procedures, office visit notes, and laboratory results.
- Assign precise CPT, ICD-10, HCPCS (and when applicable, APC/DRG) codes to all services performed, including radiology imaging, neuro procedures, office consultations, and lab tests.
- Ensure codes are sequenced according to insurance and governmental regulations to facilitate timely and accurate reimbursement for OAC.
- Maintain updated knowledge of new coding guidelines, compliance standards, and payer policy changes, especially regarding specialized coding for neuro and radiology services.
- Liaise with physicians and clinical staff to clarify ambiguous documentation and provide feedback for improved coding compliance.
- Conduct chart audits and support internal or external coding reviews, contributing to quality assurance and compliance efforts within the organization.
- Communicate any identified coding issues or discrepancies to the supervisor or compliance officer to safeguard billing integrity.
- Train new staff and educate providers on documentation and coding improvements, following industry best practices for all clinical areas.
- Ensure patient confidentiality and follow HIPAA guidelines.
- Promote a professional image by adhering to the established dress code as listed in Employee Handbook.
- Check and resolve assigned tasks in EMR program.
- Other duties as assigned by Administration.
- Assist co-workers as needed.
- Recognize when others are in need of assistance, information or directions and offers to help when able, or find someone who can.
- Responsible for neatness of work area to include stocking and cleaning. Be productive when faced with any “down time” during work hours.
- Maintain emotional control and diplomacy at all times.
- Maintain open and positive lines of communication.
- Consistently report to work on time, begins work promptly and perform duties for entire scheduled shift.
- Maintain absenteeism within company policy.
- Notify Administration of absences and tardiness in a timely manner.
- Read new policies and documents as instructed.
- Adhere to company policies and procedures.
- Demonstrate sensible and efficient use of equipment and supplies by limiting waste, spoilage or damage.
Performance Requirements:
Knowledge:
- Knowledge of medical billing and collection practices.
- Knowledge of basic medical coding.
- Knowledge of third-party payer operating procedures and practices.
- Knowledge of Medicare requirements.
- Comprehensive knowledge of medical terminology, anatomy, and clinical procedures for office visits, radiology, neuro, and lab services.
Skills:
- Proficient skills in computer programs.
- Skill in trouble-shooting insurance claims and problems.
- Skill in establishing and maintaining effective internal and external working relationships.
- Proficiency in using medical coding software and electronic health records systems.
Abilities:
- Ability to accurately enter data and examine insurance documents.
- Ability to deal courteously with patients, staff and others.
- Attention to detail.
- Strong organizational skills.
- Effective written and verbal communication skills.
Qualifications:
- A High School Diploma or GED required.
- Certified Professional Coder (CPC) required.
- Minimum two years’ experience preferred.
Physical Requirements:
- Ability to work effectively in a fast-paced environment.
- Physical ability to sit, perform data entry and view computer screen for long periods at a time.
- Occasional exposure to communicable diseases and biohazards.
- Daily standing, walking, bending, and maneuvering.
- May require lifting up to 50 pounds or more to transfer and/or turn patient with and without assistive devices.
Travel:
Travel may be required.
Scheduled Working Hours:
Normal work hours are 8:00 a.m. to 5:00 p.m., Monday through Thursday and 8:00 a.m. to 1:00 p.m. on Fridays. Hours may vary depending upon the needs of the position, department, and clinic.
Other Duties:
Please note this job description is not designed to cover or to contain a comprehensive listing of activities, duties, or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change from time to time, with or without notice.
Equipment Operated:
Standard office equipment including: computers, printers, faxes, copiers, postage machine, etc.
