CODING / AUDIT SPECIALIST - Mabry Eye

Coding/Audit Specialists-Mabry Eye Clinic

Summary/Objective:

Under direct supervision of the Supervisor – Internal Audit, the incumbent is responsible for conducting review of charges to ensure appropriate assignment of alpha / numeric procedure and diagnosis codes and modifiers as appropriate. Conducts analysis of all denied claims and review of medical record to identify coding errors, make appropriate corrections. Conduct claim re-submission or appeal as appropriate.

Essential Functions:

The following section contains representative examples of job duties that might be performed in positions allocated to this job class. Galen Medical Group is a dynamic organization, and the environment can be fluid. Roles and responsibilities may be altered to accommodate changing business conditions and objectives as well as to tap into the skills and experience of its employees. Accordingly, employees may be asked to perform duties that are outside the specific work that is listed. It is not required that any position perform all duties listed, so long as the primary responsibilities are consistent with the work as described. Performance standards developed for incumbents allocated to this job class may also contain relevant job content information and are referenced hereto.

AUDITING

• Audits medical record documentation for accurate assignment of diagnosis, current procedural terminology, and evaluation / management codes. Researches coding and reimbursement issues and reports findings to management, physicians and staff.
• Performs internal quality assessment reviews on physician (professional) coding to ensure compliance with national coding guidelines and Galen Medical Group policies for complete, accurate, and consistent coding which results in appropriate reimbursement and data integrity.
• Assists Supervisor with preparation and interpenetration of monitoring results for review with physicians, midlevel providers, and management.
• Performs compliance audits, risk assessments and investigations as it relates to billing, coding, and reimbursement compliance.

Knowledge/Expectations/Abilities:

• Records maintenance skills.
• Ability to communicate effectively, both orally and in writing.
• Ability to maintain calendars and schedule appointments.
• Ability to understand and follow specific instructions and procedures.
• Word processing and/or data entry skills.
• Skill in the use of operating basic office equipment.
• Ability to create, compose, and edit written materials.
• Organizing and coordination skills.
• Promote the mission, vision, and values of Galen Medical Group.
• Maintain confidentiality of all patient, medical, financial, and legal information.
• Report to work on time and as scheduled.
• Wear identification during work hours.
• Represent the organization in a positive & professional manner.
• Ability to handle difficult situations involving patients, physicians, or others in a professional manner.
• Ability to work independently, exercise creativity, be attentive to detail, and maintain a positive attitude.
• Comply with all organization policies and standards regarding ethical business practices.
• Participate in performance improvement and continuous quality improvement activities.
• Attend regular staff meetings and in-services as directed by your manager.
• Consistently demonstrate the value of team concept.
• Ability to manage multiple and simultaneous responsibilities.
• Complete assignments efficiently and in a timely manner.
• Understands and abides by OSHA, HIPAA & CLIA standards.

Qualifications:

Education:

• High School Diploma or GED equivalent is required.
• Associates Degree in Health Information Management is desirable.
• Certified Professional Coder (CPC) or Certified Coding Specialist – Physician Based (CCS-P) required.

Experience:

• One to three years physician coding and auditing experience preferred.
• Knowledge of pathophysiology and disease processes
• Knowledge of medical insurance and payer guidelines.
• Knowledge of the regulatory/reporting requirements that pertain to the assigned function.
• Effective organizational and problem-solving skills are required
• Demonstrated ability with medical billing / electronic medical record systems
• Knowledge of third-party billing / payment guidelines.
• Good verbal and written business communication skills

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties, or responsibilities required of the employee for this job. Duties, responsibilities, and activities may change at any time, with or without notice.

As part of the Galen Medical Group, the applicant must be a team player and provide excellent customer service while assessing our patients needs efficiently. Perform all duties in compliance with Galen Medical policies, HIPAA, and OSHA standards.

Galen Medical Group is a member of the TN Drug-Free Workplace and it is a requirement that we conduct a pre-employment drug screen, as part of the hiring process.

Why should you apply?

• 401(k) benefits.
• Education reimbursement.
• Holiday Pay.
• Great earned time-off policy.
• Company-paid Life Insurance & Long Term Disability.