The ideal applicant must have experience and knowledge in coding/billing, denials, payer rules, and analytical skills in this field.
Medical Coder Internship
The internship entails coordination and review of vendor outsourcing partners’ work, as well as assistance with training and continuing education programs Use ICD-10 CM and CPT-4 coding methods to code medical records.
Examine the medical record to ensure that diagnoses, procedures, and appropriate/optimal reimbursement professional charges are specified. Using established methods and procedures, extract information from medical records.
Duties and Responsibilities
- Regular audits and quality control for vendor services, particularly Charge Review Edits and Claims Manager Edits, are required to ensure the quality and amount of work accomplished.
- Monitor and track outsourcing vendor performance in terms of quality control and productivity.
- Examine and research difficult (problematic coding that necessitates research and reference checking) medical records, and appropriately code primary/secondary diagnoses and procedures using ICD-10 CM and/or CPT, HCPCS coding rules, and payer specific coding requirements.
- Develop and help in the development of training, presentations, and instructional resources for any topic related to continuing education programs on areas of specialization, coding, operational workflow, and quality control.
- Collaborates with various departments and partners (e.g., Revenue Integrity, Quality Assurance Team, Compliance Specialist, Internal Controls)
- Billing and Collections, and Revenue Managers) to guarantee that coding feedback is delivered to outsourced vendors and teams..
- Data from medical records are abstracted and compiled for best compensation for hospital and/or professional expenses.
- In order to give detailed coding information, consult with and provide feedback to physicians or departments on coding procedures and norms. Communicate with clinical, ancillary, and revenue managers to get necessary paperwork for correct coding.
- Develop and maintain a complete awareness of medical record procedures, standards, regulations, Health Care/ Finance Administration (HCFA) and Uniform Billing (UB-04), CMS, and other payer policies, as well as any changes in health care
- Develop and maintain a comprehensive understanding of payer-specific requirements for edit review and rejection management.
- Develop and maintain a comprehensive understanding of the payer-specific appeal process.
- Create and maintain a thorough understanding of the CMS and Palmetto Claim Processing Manuals, including Smart Edits and Claim Rejection.
The position is forward-thinking, with regular access to and communication with code vendor partners.Coding certification is essential, and auditing certification is recommended.