KEY RESPONSIBILITIES / ESSENTIAL FUNCTIONS
Assigns the appropriate Emergency Department (ED) E/M level, procedures, injections/ infusions and administration facility charges for hospital services using the facilities tools and programs for charge capture. Assigns appropriate modifiers with ICD-10, CPT and HCPCS Level codes as required.
Maintain a working knowledge of clinical/business processes and data flow to ensure that both are optimized.
Maintain productivity standards and ensure ED charge remains current or entered within 72 hours of patient discharge.
Ensure charge corrections are completed timely and accurately.
Communicate effectively with coding colleagues with positive outcome of charging questions.
Actively participate in ED and Coding education teams.
Maintain statistics / logs as required.
Perform other duties as assigned.
MINIMUM KNOWLEDGE, SKILLS, EXPERIENCE REQUIRED
Minimum Job requirements:
- Maintains performance, patient and employee satisfaction and financial standards as outlined in the performance evaluation.
- Performs compliance requirements as outlined in the Employee Handbook
- Must adhere to the DCH Behavioral Standards including creating positive relationships with patients/families, coworkers, colleagues and with self.
- Performs essential job functions in a manner that ensures the safety of patients, visitors and employees.
- Identifies and reduces unsafe practices that may result in harm to patients, visitors and employees.
- Recognizes and takes appropriate action to reduce risks and hazards to promote safety for patients, visitors and employees.
- Requires use of electronic mail, time and attendance software, learning management software and intranet.
- Must adhere to all DCH Health System policies and procedures.
- All other duties as assigned.
Preferred Job Qualifications:
- High school diploma or GED required.
- Minimum two (2) years hospital, medical billing experience.
Job Specific and Unique Knowledge, Skills and Abilities:
- Coding Licensure or other certifications:
- Degree in medical insurance billing and coding.
- Working knowledge of medical terminology, anatomy, physiology, medications, and CPT/HCPCS.
- Charge entry/capture experience, working knowledge of hospital policies and procedures, and experience with hospital EMR.
Working Conditions / Essential Tasks and Responsibilities:
- Working knowledge of Microsoft Office products required
- Understanding the composition of a medical record, and the ability to read and interpret is essential
- Displays problem solving ability, initiative, reasoning ability, decision making techniques, is detailed oriented, and appropriate use of resources
- Demonstrated ability to interact professionally on the phone and in person with staff, doctors, and supporting departments.
Medium work. Exerting up to 50 pounds of force occasionally, and/or up to 30 pounds of force frequently, and/or up to 10 pounds of force constantly to move objects.
- Identify all chargeable ED services and Supplies
- Calculate ED Evaluation and Management (E&M) level
- Identify infusion, injection, and transfusion charges per existing Current Procedural Terminology (CPT) hierarchy guidelines for ED and outpatient/bedded outpatient services.
- Enter charges, quantities, and modifiers, when indicated, within 72 hours of the patient’s discharge.
- Maintains greater than 97% completion rate of charges in less than 72 hours
- Identify deficiencies or discrepancies in nursing and/or physician documentation that affects billing and notifies the originator of the incorrect documentation to allow for proactive improvements related charge capture.
- Collaborate with other departments on routine and special project analysis to assure the accuracy and completeness of charges captured for insurance and patient billing of inpatient and outpatient hospital services.
- Assist special projects related to charge capture and rebill projects.
- Collaborate and assist other departments to address charge capture/documentation issues and assist with the development of educational opportunities.
- Serve as a communication link between clinical/billing personnel and other reimbursement specialists in discussing issues, recommendations, solutions, and answering questions related to patient charges, auditing, and charge master.
- Perform other duties as assigned.
- Must be able to reach reasonable distances in any direction
- Must be able to stand, walk, kneel, bend, sit, stoop and lift
- Must be able to run in an emergency
- Must be able to move fingers in a coordinated manner and must be able to feel and perceive temperature, texture, shape and size with fingertips
- Reading, Writing, Reasoning, Talking, Keyboarding
- Must be able to perform the duties with or without reasonable accommodation
- Hearing and vision must be normal or corrected to within normal range
- Must possess stamina to work 8 hours.