Carries Out Evaluation and Management coding, procedure, ICD-10 and HCPC quality examines along with other jobs related to doctor coding compliance. Informs doctors and center staff on correct scientific coding and documentation standards and rules. Demonstrates a comprehensive understanding of complicated coding, reimbursement, and auditing principles as they connect to doctor practices and clinic settings. Keeps notified regarding current coding regulations, expert standards and company/department policies and treatments and successfully uses this knowledge.
NECESSARY FUNCTIONS: To perform this task, an individual must carry out each essential function sufficiently with or without a reasonable accommodation.
- Finishes coding training with physician/practitioner and personnel.
- Carries out quality evaluations in a timely way.
- Conducts random quality evaluations for companies as set up.
- Conducts re-reviews based upon escalation criteria as set up.
- Carries out treatment quality examines as arranged.
- Help in educating coders/billers of code modifications.
- Guarantee completion of action plan products.
- Regular and trusted attendance at meetings.
- Perform other duties as assigned
Additional Information:
Position serves both internal colleagues and external doctor practice service providers, coders, and billers.
Access to and/or works with sensitive and/or confidential information.
Exhibition a detailed understanding of healthcare regulative and compliance (e.g., HIPAA).
SUPERVISORY RESPONSIBILITIES:
Not responsible for monitoring employees.
Certifications
UNDERSTANDING, ABILITIES & ABILITIES: The requirements listed below are representative of the knowledge, skills and/or capabilities needed.
Education: High School Diploma or GED comparable
Experience: 2 years of experience
Certifications: Two of the following certifications (or eligibility therefor):
- CPC
- CEMC
- CPMA
- CRC
- CPB
- Specialty certification
- CCS-P
- RHIT
Skills and Capabilities:
Service Mathematical Abilities– Capability to add, subtract, increase, and divide in all units of step, using entire numbers, common fractions, and decimals. Ability to calculate rates, ratios, and portions and to draw and analyze graphs.
Moderate Computer Systems Abilities– Regular usage of electronic mail, word processing, information entry, spreadsheets, graphics, and so on. Capability to create, keep and incorporate easy functions into files, spreadsheets, databases, and discussions to support service goals.
Complex Communication– Often interacts intricate information and communicates with management. Can provide, deal with and deal with delicate scenarios. Can inspire and encourage others.
Department Specific Effect– Choices affect the management and operations within a department. May add to service and operational decisions that affect the department.
Regimen Service Issues– Problems come across are regular, somewhat repeated and generally resolved by following clear directions and treatments.
Fundamental Judgement– Outcomes are specified and existing practices are utilized as standards for how to finish work activities; works carefully with supervisor/manager who provides broad guidance and overall instructions
Moderate Planning/Organization– Handle multiple jobs concurrently with moderate intricacy.
PHYSICAL AND MENTAL DEMANDS:
The physical needs explained here are representative of those that should be met by a worker to effectively carry out the important functions of this task. Reasonable lodgings might be made to enable individuals with impairments to perform the vital job responsibilities.
While carrying out the duties of this task, the staff member is periodically required to stand; walk; sit for extended periods of time; utilize hands to finger, manage, or feel objects, tools or controls; reach with hands and arms; climb stairs; balance; stoop, kneel, bend, crouch or crawl; talk or hear; taste or odor. The employee should periodically lift and/or move up to 20 pounds. Repetitive motion of upper body required for extended use of computer. Needed particular vision abilities consist of close vision, range vision, color vision, peripheral vision, depth perception, and the capability to adjust focus.
WORKPLACE AND TRAVEL REQUIREMENTS:
Workplace characteristics described here are representative of those that a worker may experience while carrying out the essential functions of this task. Sensible accommodations may be made to allow individuals with impairments to carry out the important job obligations.
Works in well-lit, aerated and climate controlled office environment with routine office equipment; some equipment has moving mechanical parts.
In healthcare facility environment, might be exposed to hazards and unusual components, which may consist of however are not restricted to bloodborne pathogens and/ or infectious illnesses, toxic chemicals, and biohazardous materials which may need substantial security precautions and using protective equipment.
Noise level in the work environment is typical for a workplace and/or medical facility environment.
Minimum overnight travel (as much as 10%) by land and/or air.
Los Alamos Medical.
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