Evaluates medical record documentation and charge ticket coding to optimize reimbursement by ensuring that diagnostic and procedural codes and other documentation accurately reflect and support the E&M codes generated by the practice.  Also performs reviews for completeness of record to ensure accuracy and compliance with the International Classification of Diseases Manual- Clinical Modification (ICD-10-CM), and the American Medical Association's Current Procedural Terminology Manual (CPT).    Works in conjunction with other staff members within ProBill to ensure daily and monthly deadlines are met.  Identifies opportunities for coding improvement or charge capture, and reviews and makes necessary changes under the direction of the Physician or Provider as well as Management as needed.  Provides Physician, Provider, and support staff education as needed.  Responsible for monthly reports on WRVU calculation for physician and extender productivity under GHI, Inc. Works to ensure the organization and providers are CMS and Medicaid compliant and keeps staff and providers updated in the changing environment. Oversees the accurate posting of payments and adjustments, the transferring of accounts and posting of payment, adjustment for bad debt accounts.  Responsible for debt setoff reporting to the State, Escheat reporting and is responsible for timely correction of posting errors.  Reports to Administrative Director of PFS on Probill performance of collection percentages, payor mix, and bad debt.  Reports clinic and individual provider performances via RVU and dollars billed.  Prepares and maintains accurate RHC counts, bad debt logs, and dollars for yearly cost reporting. Ability to work with all staff and performs annual competency evaluations of staff.  Acts as a support resource for staff providers and administration.  Performs other duties as assigned.

Qualifications:  

High School Diploma or equivalent.   Medical Practice Billing experience, with experience in electronic claim submission. Experience with collection processes and procedures.                          

Preferred Qualifications:

• Associates degree in Medical Office Administration or related field.
• Medical Coding certification, CPC or AHIMA. 
• Supervisory experience.             

Job specific and technical competencies for this position include the following: 
• Working knowledge of Medicare, Medicaid and Rural Health rules and regulations.  
• Working knowledge of Word, Excel and Microsoft Office suite. 
• Ability to act as liaison between patients and the organization, with ability to maintain strict confidentiality.  
• Ability to educate staff, practices, administration and providers in a collaborative manner.  
• Multitasking ability required.

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