Responsibilities:Assures that all services documented in the patient’s chart are coded with appropriate ICD-10 and CPT codes for Family Practice Medicine, Neurology, OB/GYN and Psychiatric specialties. When services/diagnosis are not documented appropriately, seeks to attain proper documentation in a timely manner according to facility standards. Ability to maintain average productivity standards for Outpatient Facility of 20 charts per hour. Utilizes 3M, AHLTA, CCE, CHCS, HAIMS.

Under general supervision, plans and implements curriculum and educational programs for students within the program. Communicates class content to students so that learning occurs, skills are developed, and students are motivated to learn and achieve their educational objectives.

Responsibilities:Maintains a working knowledge of ICD-10-CM and coding principles, DoD specific guidelines, governmental regulations, official coding guidelines, and third party requirements regarding documentation and billing. Assures that all services documented in the patient’s chart are coded with appropriate ICD-10 and CPT codes for Emergency Department, Family Practice Medicine, Neurology, Physical Therapy and Psychiatric specialties. When services/diagnosis are not documented appropriately, seeks to attain proper documentation in a timely manner according to facility standards. Ability to maintain average productivity standards as follows: ED/Outpatient Facility - 15 charts per hour. Utilizes 3M, AHLTA, CCE, CHCS, HAIMS.

Maintains a working knowledge of ICD-9-CM and ICD-10-CM and coding principles, Governmental regulations, official coding guidelines, and third party requirements regarding documentation and billing. Assures that all services documented in the patient’s chart are coded with appropriate ICD-9, ICD-10 and CPT codes. When services/diagnosis are not documented appropriately, seeks to attain proper documentation in a timely manner according to facility standards. Ability to maintain average productivity standards set by the client for Ancillary, ED and Multi-Specialty Outpatient Clinics. Works the edit and review queue on a daily basis to ensure all charts that are placed in the review queue are worked and any corrections are communicated to the facility if necessary. Utilizes 3MHDM, 3MCAC, Cerner and EPIC systems.

Responsible for abstracting diagnosis codes from provider documentation, entering essential information into a proprietary database. Validates diagnosis codes, ensuring the highest level code is utilized in each date of service reviewed. Ensures documentation is sufficient to support clinical findings. Adheres to client specific policies and procedures, official coding guidelines, coding clinical determinations, CMS and other regulatory compliance guidelines and mandates. Responsible for meeting daily and weekly production and quality goal. Proficient use of ICD-9-CM diagnosis and coding techniques. Other duties as assigned.

Analyze and abstract from both EMR and handwritten documentation for accurate and timely coding of ICD-9 CM, E&M, (using both 1995 and 1997 guidelines), CPT 4, and HCPCS. Evaluates medical records to ensure completeness and accuracy. Reviews office and outpatient records and interprets documentation to identify all diagnoses and procedures for an Acute Care Center and Multi-specialty Clinic. Ensure injections and infusions are coded and properly according to CMS and private insurance payer guidelines. Assigns proper single and sequence multiple, diagnosis and procedure codes in accordance with Official Coding Guidelines and to ensure appropriate provider and facility reimbursements. Query physicians as required by employer to complete coding accurately.Assess the adequacy of medical record documentation to ensure it supports all reportable diagnoses and procedures.Complies and reports daily, weekly and monthly workload statistics. Utilizes medical data systems such as Greenway and Optum Encoder Professional. Responsible for meeting daily production and quality goal. Other duties as assigned.

Served as the Clear and Legible Reports (clinical and medical reports) Coordinator for the Kenner Army Health Clinic Military Treatment Facility. Generated and maintained the medical report tracking and retrieval process to ensure all referrals are appropriately closed with either completed results or appropriate administrative closure.Maintained medical report tracking and retrieval process. Reviewed medical records for completeness, accuracy, and compliance with applicable medical facility and accreditation standards. Retrieved x-rays, laboratory reports, and other relevant patient data. Utilized office automation equipment, word processing software, and mission specific medical software to compile and type a variety of material including progress reports or memos.Complies and reports monthly workload statistics for review by NARMC. Utilizes medical data systems such as AHLTA, CCS, CHCS, HAIMS, HealthNet and myTRICARE for abstracting data related to specialty referrals to consult patients and providers of the referral and authorization process. Knowledge of military healthcare delivery systems, health system benefits, eligibility determinations, and TRICARE.

Performs medical record reviews remotely through an application service provider model (Recon Edge) from physician/professional, hospital outpatient and hospital inpatient medical charts.Responsible for auditing diagnosis data collected to ensure proper ICD-9 coding and compliance with risk adjustment requirements set by CMS. Responsible for validating diagnosis codes, ensuring the highest level code is utilized in each date of service reviewed and that available documentation is sufficient to support clinical findings in company data storage program. Professionally communicates findings and errors to quality managers for conditions documented within the medical record or not captured during first pass coding.Adheres to client specific policies and procedures, official coding guidelines, coding clinical determinations, CMS and other regulatory compliance guidelines and mandates. Proficient use of ICD-9-CM diagnosis and coding techniques.Strong knowledge of medical terminology and anatomy and physiology. Responsible for confidentiality of medical records and personal information in compliance with HIPAA regulations.

Provides administrative support to the Director and Clinical Coordinator of Pharmacy Services by performing general receptionist and clerical duties. Responsible for scheduling and coordinating meetings for medical and nursing staff committee meetings to discuss policy and procedures relating to medication management and patient safety. Responsible for ensuring that all inpatient and outpatient drug charges are captured in an appropriate and timely manner. Reviews patient account records and third party payer issues. Identifies, analyzes, and reconciles billing errors or omissions. Knowledge of third party and insurance procedures, regulations and billing requirements, and government reimbursement programs. Audits medical records to ensure compliance with the organization's coding procedures and standards. Assists with educating department staff and other Ancillary departments on potential improvements in charting and provides feedback to the pharmacy and nursing staff to ensure compliance across the organization. Assists with educating staff on changes in the CMS requirements for charging. Maintains current knowledge of ICD-9 and CPT coding procedures.

Under the direct supervision of a registered pharmacist, compounds and dispenses medication orders for inpatient and outpatient care. Performed a variety of techincal and electrical duties for the hospital-wide automated medication dispensing system (Pyxis®)Prepares intravenous medications using expertise in the safe handling and use of chemotherapeutic and other agents which require special handling or preparation procedures. Maintains certification through the National Pharmacy Certification Board.

Reviewed clinical documentation to select and sequence the appropriate ICD-9 CM and HCPCS procedure codes.Abstracted information from Inpatient, Outpatient and Urgent Care medical charts for professional billing.Utilized 3M Encoder, CMS Website, and Meditech software to code and process professional claims for Medicare, Medicaid, and other private insurance carriers electronically.Knowledge of medical terminology, ICD-9, CPT, HCPCS, HIPAA Guidelines, Medicare and Medicaid guidelines.Performed follow-up on problem claims.

Received inbound telephone calls or paper, and electronic claims for members and providers. Resolved issues for members, providers, and group administrators and brokers. Interpreted claims to determine primary or secodary liability and recognized when additional information was needed to ensure the provider received proper reimbursement and the policy holder the correct benefits. Knowledge of policies and procedures, products, legislation, and claims workflow to ensure customer/client requests were handled appropriately.