Professional Billing: Specialty Ambulatory, Cardiology focused - Adult, Pediatric/CongenitalPrevious departments: Adult Cardiology, Critical Care E/M and Bedside Procedures-Responsible for reviewing provider/APP documentation and assigning appropriate diagnoses and procedure codes for reimbursement purposes-Compliance: ICD guidelines and quarterly updates, CMS guidelines, organization standards (quality/productivity), and HIPAA-Provide education/guidance for providers/APPs regarding code selection and documentation standards/requirements; utilize Tableau to identify trends in provider/APP codes, conduct biannual 1:1 meetings to relay new coding guidelines, requirements, and trends.

-Analyze and investigate authorization requests for medical/surgical IP/OP requests for providers caring for Blue Care Network (HMO) members-Facilitate communication with providers regarding authorization statuses/requirements-Prepare incoming requests for referrals, authorizations; perform preliminary review for medical necessity before routing for additional review-Responsible for understanding policies, procedures, and guidelines for approving, denying, or pending past, present, or future requests

-Communicate with patients, physician offices, and insurance companies regarding authorization/certification requirements; ensure authorizations are obtained for scheduled procedures for all Beaumont sites-Screen OP visits for medical necessity; provide cost estimations for procedures/visits; collect information required for third-party payers (MVA, WC)-Utilization of ICD diagnosis and procedure codes for IP/OP surgical authorizations across all specialties

-Gather patient demographic, clinical, and insurance information upon ER arrival; input information in an accurate and timely manner-Review, obtain, and witness patient documents: consent(s) to treat, HIPAA Notice of Privacy Practices, Medicare IP Rights, and financial responsibility

Gained valuable clinical experience while developing skills and confidence to provide competent patient care.