Serves as the principal resource for documentation, coding and reimbursement research and education for Billings Clinic providers, staff and leadership. Educates physicians through group and individual sessions on the full circle of proper revenue cycle practices regarding clinical documentation, coding, reimbursement, denials and appeals. Strives to maximize reimbursement by educating providers in appropriate clinical documentation as it pertains to coding and billing. Provides feedback to providers and management by auditing as needed for proper documentation and coding. Analyzes and reports coding distribution and trends in clinical denials to providers and management. Analyzes payer bulletins and regulations and interprets them for Billings Clinic. Researches appropriate billing methodologies and implements them for new procedures or technologies. Works closely with the Reimbursement department and Information Services on changes to the electronic charge entry systems. Works closely with Billings Clinic leadership to ensure coding and compliance guidelines are adhered to, the Cerner Charge build and fee schedule are correct and high risk areas are identified, reported, and appropriate steps are taken.
Essential Job Functions
• Supports and models behaviors consistent with Billings Clinic’s mission, vision, values, code of business conduct and service expectations. Meets all mandatory organizational and departmental requirements. Maintains competency in all organizational, departmental and outside agency standards as it relates to the environment, employee, patient safety or job performance.
• Educates staff in accurate documentation, coding, billing and reimbursement with primary emphasis on educating the providers.
• Coordinates and completes coding, reimbursement, compliance, and internal audits including any monitoring activities that require a review of relevant information. Such reviews may be part of the annual audit work plan or as assigned throughout the year. Audits data to ensure that coding and documentation at Billings Clinic meets set standards.
• Reviews, analyzes and interprets coding changes and billing regulations and disseminates information. Monitors and audits records for compliance with regulatory changes in documentation.
Analyzes and researches government and third party payer policies and updates for coding and reimbursement content. Appeals for changes in these policies when appropriate.
• Researches and audits new technologies and new service lines for compliant coding, documentation requirements in conjunction with reimbursement information... Meets with equipment and drug vendors to ensure proper reimbursement for new equipment/products.
• Coordinates effort to ensure that charge masters are updated appropriately on a regular basis. This includes participation in annual CDM/Code reviews, identifying enhancements in fee structure and making sure that electronic charge capture tools are accurate.
• Responsible for coding and abstracting diagnoses and procedures from patient charts using ICD and CPT/HCPCS codes for statistical and reimbursement purposes for all Billings Clinic inpatient and outpatient services.
• Researches and responds to questions from Billings Clinic leadership and staff. Performs other duties as assigned or needed to meet the needs of the department/organization. May conduct other special projects as assigned.