United Surgical Partners International Inc (USPI)
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at United Surgical Partners International Inc (USPI)
Under the direction of the Business Office Manager, the Coder/Biller is responsible for assuring that the Ambulatory Surgery center's medical records are coded and abstracted according to established criteria utilizing available resources both automated and manual based on documentation in the medical record provided by the attending, consulting physicians and clinical information. Using the available automated systems, enters coded documentation in the medical records on a daily basis. Communicates with consultants, federal and state organizations to validate the coding process and assure compliance to prevent fraud and abuse related to coding and abstracting. Validates documentation and works with the physicians to assure proper coding and educates the medical staff regarding coding issues.
DUTIES AND RESPONSIBILITIES:
1.Assures that proper documentation is available in the medical record prior to coding and that it is complete.
2.Code diagnoses, procedures, complications and co-morbidities for all patients accurately for two ambulatory surgery centers.
3.Demonstrates knowledge and remains current in regard to ICD’s current version, CPT codes, and modifiers. 4.Identifies additional charges for implants and devices, applying appropriate HCPCS codes.
5.Verifies insurance contract fees for each procedure, device, or implant.
6.Enters charges into patient accounting system. Follows through to assure the coding is finalized so that the claim can be generated.
7.Daily prepares report of non-entered charges, reconciles errors, and forwards the information to AR for claim submission.
8.Remains current with the coding and processing of records to assure timely coding.
9.Utilizes the available automated systems to achieve peak efficiency and accuracy.
10.Demonstrates expertise in the use of the automated systems and any other that may pertain to coding.
11.Maintains required certification and training in the area of coding and abstracting.
12.Interacts positively, friendly and professionally with physicians, patients/family, office staff, hospital staff, medical supply company representatives, insurance companies, attorneys, worker’s compensation adjusters and others.
13.Identifies opportunities to teach co-workers, medical staff and professionals regarding the documentation of medical care which supports accurate coding.
14.Speaks clearly, concisely and with consideration and respect in a group or one-on-one. Articulates thoughts wells and has a good rapport with listeners. Communication is clear, concise and understandable. Presentation is always polite, considerate and patient. Listens well.
15.Additional business office functions as determined by supervisor
SKILLS AND ABILITIES: 1.Able to work independently and meet established deadlines. 2.Able to make sound reasonable decisions. 3.Highly organized. 4.Ability to concentrate on many detailed requests despite numerous interruptions and respond accordingly with an appropriate sense of urgency. 5.Demonstrates accountability, professionalism, openness, receptive to change, creativity and innovation. 6.Ability to identify and calmly handle inherently stressful situations with tact. 7.Excellent communication skills. 8.Ability to develop excellent working relationships with consumers, vendors and staff. 9.Seeks guidance, direction and assistance when needed.
EDUCATION, TRAINING AND EXPERIENCE REQUIREMENTS:
1. 5 years in medical environment with experience coding in an ASC environment (including Orthopedics, Pain management, GI, General, Gynecological, ENT, Ophthalmology, Plastic, Urology). Certification required. (American Health Information Management Association (AHIMA), the American Academy of Professional Coders (AAPC) or other nationally recognized authority on hospital coding)
2.Associates degree in business or clinical area or equivalent work experience.
3.Must be able to communicate and understand the English language both verbal and written.
4.Computer literate. Experience and knowledge of Advantx and Microsoft Office product required.
5.Knowledge of medical terminology.
6.Knowledge of managed care contracts.