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in Weston, FL

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Hours Full-time, Part-time
Location Weston, FL
Weston, Florida

About this job

Job Summary:

Evaluates and monitors physicians' professional coding of evaluation and management (E&M) and other CPT-4 procedural codes for accuracy prior to claim submission. Interprets and analyses medical record documentation and applies correct coding principles as defined by regulatory agencies (such as CMS, AMA, The Coding Clinic) and standards of ethical coding. Upon completion of accurate coding (including decisions related to global periods, modifiers, bundling rules, and identifying missing codes), appropriate codes and related charges are submitted for billing. Reviews and discusses discrepancies between documentation and code selection with the physician/provider for clarification and educational purposes. Maintains knowledge base by reviewing coding and reimbursement newsletters, attending in-service training sessions and participating in continuing education workshops.

Responsibilities:

* Consults with physicians, managers, and support staff to clarify documentation and interpret clinical information necessary to correct claims in review status for Claims Manager.

* Interacts with Reimbursement Specialist to ensure most productive and current charge tickets. Identifies omissions and /or errors.

* Ensures charge reconciliation procedures exist for all charges and resolve individual issues when identified.

* Assists charge entry personnel with CPT/ICD-9 coding.

* Provides communication between Reimbursement Department, physicians and necessary personnel.

* Uses the Claims Manager, ICD-9-CM and CPT coding systems to accurately code all professional services.

* Follows policies and procedures as it pertains to Claims Manager corrections and processes.

* Identifies compliance risks and issues in accordance with policies described in the Cleveland Clinic Corporate Compliance Manual.

* Maintains patient and employee confidentiality at all times as it pertains to review of medical records.

* Adheres to CMS/Medicare Part B coding guidelines and principles.

* Tracks and trends physician/departmental coding patterns and reports same to the Reimbursement Manger/Supervisor. Implements Claims Manager Edit requests when necessary through appropriate request processes.

* Advises Reimbursement Manager of modification needed to the Claims Manager process.

* Maintains complete and up-to-date documentation and files at all times.

* Other duties as assigned.

Education:

* High School Diploma.

* College degree or technical training preferred.

* Anatomy/physiology course or related experience in order to classify proper procedure codes and communicate with physicians and staff.

Certifications:

* Certified Professional Coder (CPC) and/or Certified Coding Specialist - Physician (CCSP) certification required.

Complexity of Work:

* All employees are expected to meet the standards of performance outlined in the Organizational-Wide Competencies listed below as applied to the position:

* World Class Service Orientation: Includes attitude, behavior, interpersonal skill, and problem solving that enable an employee to respond to internal and external customer needs and expectations in a positive manner.

* Adaptability: Includes teamwork and flexibility needed to fulfill job responsibilities including adapting to changes in work environment and accepting supervisory feedback.

* Efficiency and Effectiveness: Includes quantity and quality of desired work, as well as organization skills necessary to perform successfully

* Essential Job Requirements: Includes adherence to all relevant policies, procedures, and guidelines affecting the work environment, including maintenance of required competencies and communication skills.

* Supervisory Responsibilities (if applicable): Includes overall accountability for assigned work group relative to operational goals, personnel requirements, and budgetary constraints.

* Note: The above stated duties are intended to outline those functions typically performed by individuals assigned to this classification. This description of duties is not intended to be all inclusive or to limit the discretionary authority of supervisors to assign other tasks of similar nature or level of responsibility.

* Knowledge of HCFA and Medicare regulations.

* Knowledge of finance/accounting/billing. Knowledge of clinical and medical terminology.

* Organizational skills, attention to details, ability to prioritize and manage multiple projects at one time, and meet deadline.

* Ability to complete assignments independently with little or no supervision.

* Outstanding verbal and written communication skills required to effectively work with personnel at all levels.

* Excellent problem resolution skills.

* Ability to utilize proper chain of command.

* Ability to use Microsoft Office Suite (Word, Excel, Access).

Work Experience:

* Minimum of two years of multi-specialty CPT and ICD-10-CM coding experience for Part B professional service.

* Extensive CPT and ICD-10-CM training or experience.

* Analytical skills developed through formal or experience with medical practice or other health care organizations.

* Claims Manager-Ingenix, DOS, Group Wise, and /or Internet experience helpful.

Physical Requirements:

* Essential Duties: The ability to retrieve, communicate or other wise present information in written, auditory, or visual fashion is essential. The methods used to express or exchange ideas are by spoken or written word. Telephone and manual dexterity skills are also required.

* Physical Duties: The position requires prolonged periods of sitting with a light amount of physical work, with maximum lifting of 20 pounds and frequent lifting and carrying of documents weighing up to 10 pounds. Activities may include reaching, pulling, pushing, bending, and stooping.

* Working Conditions: This individual spends almost 100% of his/her time in an air-conditioned building.

Personal Protective Equipment:

* Follows Standard Precautions using personal protective equipment as required for procedures.

The policy of Cleveland Clinic and its system hospitals (Cleveland Clinic) is to provide equal opportunity to all of our employees and applicants for employment in our tobacco free and drug free environment. All offers of employment are followed by testing for controlled substance and nicotine. Job offers will be rescinded for candidates for employment who test positive for nicotine. Candidates for employment who are impacted by Cleveland Clinic's Smoking Policy will be permitted to reapply for open positions after 90 days. Decisions concerning employment, transfers and promotions are made upon the basis of the best qualified candidate without regard to color, race, religion, national origin, age, sex, sexual orientation, marital status, ancestry, status as a disabled or Vietnam era veteran or any other characteristic protected by law. Information provided on this application may be shared with any Cleveland Clinic facility.

Cleveland Clinic is pleased to be an equal employment employer: Women/Minorities/Veterans/Individuals with Disabilities