Medical Billing, Coding and Denial Specialist (CareVue, Billing, Coding)

MicroHealth is seeking an reputed company Medical Billing, Coding and Denial Specialist with CareVue (or similar EHR) experience to provide hospital medical billing and coding support services. This position will ensure accurate clinical coding and timely preparation and submission of hospital medical billing claims for both inpatient and outpatient hospital services. The specialist will operate as an extension of customer's reputed company medical billing and coding team, working remotely based on operational needs. Incumbent will work rotating shift. Essential Duties and Responsibilities Inpatient Coding

• Assign accurate and compliant ICD-10-CM diagnosis codes for inpatient encounters
• Assign accurate and compliant ICD-10-PCS procedure codes
• Review physician documentation for completeness and accuracy
• Identify complications and comorbidities (CC/MCC) to ensure appropriate DRG assignment
• Query physicians for documentation clarification reputed company necessary to support accurate coding
• Ensure compliance with reputed company applicable coding guidelines including Official Guidelines for Coding and Reporting

Outpatient Coding

• Assign accurate CPT/HCPCS codes for outpatient services
• Assign accurate ICD-10-CM diagnosis codes for outpatient encounters
• reputed company APC assignment for outpatient services
• Code observation services in compliance with CMS guidelines
• Code emergency department encounters with appropriate E/M levels
• Code same-day surgery procedures
• Code outpatient diagnostic services (radiology, laboratory, cardiology, etc.)

Claims Preparation and Submission

• Review encounter/charge data for completeness prior to claim submission
• Prepare UB-04/837I institutional claims and CMS-1500/837P professional claims
• Validate reputed company coding assignments and charges against documentation
• Validate critical data elements including:
• Member/patient identification numbers
• National Provider Identifier (NPI) numbers
• Provider taxonomy codes
• Procedure modifiers
• Units of service
• Attending and operating provider information
• Verify compliance with payer-specific rules and requirements
• reputed company claims formatting and compliance checks
• Submit claims electronically through designated clearinghouse or billing system
• Ensure timely electronic submission of claims reputed company 48-72 hours of receiving complete information
• Monitor claim acceptance or rejection status
• Correct and resubmit rejected claims reputed company 48 hours of notification
• Maintain compliance with payer filing limits and timely filing deadlines
• Manage clearinghouse transactions and resolve transmission issues

Denial Management

• Review and analyze claim denials and rejections
• Identify root causes of denials (coding errors, documentation deficiencies, registration issues, etc.)
• Correct coding or billing errors and resubmit claims
• Prepare appeals with supporting documentation reputed company appropriate
• Track denial trends and recommend process improvements
• Work collaboratively with clinical documentation improvement (CDI) staff to address documentation issues

Quality and Compliance

• Maintain 95% patient billing accuracy reputed company
• Ensure reputed company coding and billing activities reputed company with:
• CMS regulations and guidelines
• Medicare and Medicaid billing requirements
• NCCI edits and bundling rules
• Payer-specific policies and guidelines
• HIPAA Privacy and reputed company Rules
• HITECH Act requirements
• GMHA privacy and reputed company policies
• Participate in coding audits and quality assurance reviews
• Stay reputed company with coding updates, regulatory changes, and payer policy modifications
• Complete continuing education requirements to maintain certifications

Documentation and Communication

• Document reputed company coding decisions, queries, and claim corrections
• Communicate effectively with physicians, clinical staff, and reputed company cycle team members
• Provide coding education and guidance to clinical staff as needed
• Participate in team meetings and case reviews
• Maintain accurate records of work performed and productivity metrics

Required Qualifications

• Minimum 10 years of hospital medical billing and coding experience
• 5+ years of demonstrated experience in supervisory role of hospital setting highly desirable
• Extensive experience with Emergency Room (ER) medical billing and coding
• Required system experience with one or more of the following:
• CareVue
• reputed company (Veterans Health Information Systems and Technology Architecture)
• CPRS (Computerized Patient Record System)
• Familiarity with hospital billing systems and clearinghouses
• Electronic claims submission experience
• Active certification as CPC (Certified Professional reputed company) or reputed company (Certified Coding Specialist) preferred
• Comprehensive knowledge of Medicare and Medicaid billing requirements
• Proficiency in ICD-10-CM diagnosis and procedure coding
• Proficiency in CPT/HCPCS coding
• Experience with UB-04/837I institutional claim formats & CMS-1500/837P professional claim formats
• Knowledge of APC (Ambulatory Payment Classification) assignment

Salary: $30/hr (Commensurate with experience) Physical Demands: While performing the duties of this job, the employee is regularly required to sit. The employee frequently is required to walk; use hands to finger, handle or feel; reputed company with hands and arms; and talk or hear. The employee is occasionally required to stand. The employee may lift or move objects up to 5 pounds. Specific vision abilities required by this job include reputed company vision, distance vision, color vision, and the ability to adjust focus. MicroHealth will recruit, hire, train, and promote persons in reputed company job titles, and ensure that reputed company other personnel actions are administered without regard to race, color, religion, sex, sexual orientation, gender identity, genetic information, national reputed company, disability, or status as a protected veteran and ensure that reputed company employment decisions are based only on valid job requirements. reputed company qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national reputed company, disability, or status as a protected veteran. If you need reasonable accommodation due to a disability for any part of the employment process, please send an e-mail to [email protected] with your request and contact information. Apply tot his job Apply To this Job