Major Responsibilities:Responsible for maintaining current knowledge of coding regulations for the HME/RT (Home Medical Equipment/Respiratory Therapy) business line and communicating changes/updates to the appropriate departments (i.e. Finance/Accounting, Intake/Customer Service; Data Entry, Insurance Verification).Collaborates with the Purchasing department to ensure that the inventory of product is current and up-to-date related to the coding of equipment, and to ensure the proper equipment is matched to the proper HCPCS code.Conducts system audits to ensure that HCPCS codes and ICD-9 codes are current, appropriate for use, and in the revenue cycle for the HME/RT business line to decrease the probability of denials.Performs audits on denied claims and corrects coding errors and problems. Communicates errors and trends to the appropriate department and provides education to the staff.Responsible for researching, interpreting, and implementing state and federal changes/guidelines related to the coding process of durable medical equipment (DME) and how the changes impact the revenue cycle, while remaining compliant with all state and federal regulations and guidelines.Educates staff and acts as a resource for information relating to coding, tracking and compliance as it correlates to the HME/RT product line. Educates staff on the following: Medicare qualifying changes/updates as it relates to specific equipment, HCPCS/ICD-9 code updates/changes, CMN (Certificate of Medical Necessity) coverage updates/changes, and Medicare/Medicaid and Commercial reimbursement guidelines and payor updates/changes relating to code requirements for proper billing of services.Evaluates current processes and makes recommendations for improvement(s) and/or corrections related to the revenue cycle, software applications, and post delivery of services.Communicates issues related to the billing of services and reports any finding regarding the analysis/evaluation of the revenue cycle to department leadership.
Licensure, Registration, and/or Certification Required:None Required.
Education Required:Advanced training beyond High School that includes the completion of an accredited or approved program in Medical Coding Specialist.
Experience Required:Typically requires 5 years of experience in health information coding that includes experiences in ICD-9 and HCPCS coding, policy and procedures.
Knowledge, Skills & Abilities Required:Understanding of Medicare, Medicaid and Commercial Insurance billing, coding, and regulations.Experience in the Dezine software application as it relates to the HME/RT business line.Proficient computer skills including the use of Microsoft Office Suite (Word, Excel, Access and Power Point), and Crystal Reports.Excellent communication skills in order to educate staff.Ability to work independently and efficiently under pressure.Excellent organizational skills that maintains a focus on the analysis and interpretation of data and is able to communicate the findings in an efficient manner.
Physical Requirements and Working Conditions:Exposed to a normal office environmentOccasionally lifts up to 10 lbs. Exposed to a warehouse environment occasionally.Operates all equipment necessary to perform the job.
This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.