Principal Duties and Responsibilities:

1. Comprehensive understanding of ICD-10 / CPT/ HCPCS guidelines, including the proper use of modifiers. Understands medical terminology and MAH approved abbreviations. Maintains compliance with established coding guidelines, third party reimbursement policies, regulations and accreditation guidelines.

2. Abstracts all necessary information and assigns codes (ICD-10, CPT & HCPCS) that most accurately describe each documented diagnosis, type of encounter, surgical procedure and special therapy or procedure according to established guidelines and regulations. Continuously monitors third-party documentation requirements and updates.

3. Provides all Practice Management System and/or Coding training to new and established practices, new providers and new staff members. The Certified Physician Coder will assist the Client Services Manager with all training needs to both the providers and office staff. Training may be one on one or in a group setting.

4. Performs prospective internal compliance reviews of provider coded encounters of assigned providers. Assures the presence of all component parts such as: patient and record identification, signatures and dates where required. Evaluates the record for documentation consistency and adequacy. Ensures that the ICD-10, CPT & HCPCS accurately reflect the care and treatment documented. Provides written and/or oral feedback to the provider.

5. Reviews coding activity reports for assigned billing areas as needed for accuracy and ensures that claims are properly coded for first submission (i.e. proper use of modifiers, diagnosis mapping).

6. Maintain trending reports for the Client Services Manager to help identify issues/trends that contribute to the success of the organization (i.e. registration, reconciliation of charges).

7. Assists the Client Services Manager in resolving organization wide coding issues that may improve efficiency and reimbursement. May participate in meetings as needed with providers and or staff to address Practice Management System and/or coding issues.

8. Provide guidance and timely responses to customer service questions and requests.

9. Establish and maintain communication with MAPS practice sites in order to identify and address business office needs.

10. Other duties as assigned.

KNOWLEDGE, SKILLS, AND ABILITIES REQUIRED

1 Associates degree in a related field or equivalent in training and experience preferred.

2. Five years of relevant experience preferred, including physician billing and/or medical practice management. Extensive knowledge of Third-party carrier reimbursement guidelines, and HCFA regulations.

3. Three years of experience with IDX (GPM) medical billing and appointment scheduling software preferred.

4. Minimum of two years, certified professional coding experience required: Certified Professional Coder (CPC), Certified Coding Specialist for Professional Services (CCS-P).

5. Extensive experience with chart abstracting required.

6. Experience with Microsoft Excel, Word Perfect, Windows, PowerPoint, Access Database Software, and ProComm Plus preferred.

7. Strong written and verbal communication and analytical skills to represent MAPS Physician billing both internally and externally on matters relating to reimbursement.

8. Local travel required. Valid Massachusetts driver's license required.