Job Description SummaryThe purpose of this position is to provide and ensure accurate, complete and timely capture of all professional services. Opportunity to work from home/remote within the state of South Carolina.
EntityUniversity Medical Associates (UMA) Only Employees and Financials
Cost CenterCC002053 UMA CORP RC PPA CRC CC
Pay Rate TypeHourly
Scheduled Weekly Hours40
· Upon review of documentation, perform extraction of all CPT, ICD-9-CM, HCPCS and applicable modifiers. Ensure proper procedures are followed and meet requirements of all Federal, State and Third party payers as well as UMA compliance initiatives.
· Review documentation to validate accuracy of chosen CPT, ICD-9 CM, HCPCS and applicable modifiers. Ensure proper procedures are followed and meet requirements of all Federal, State and Third party payers as well as UMA compliance initiatives. Interact in a professional manner on a daily basis with the clinicians and staff in person, via email, or on the telephone. Must be able to educate these individuals regarding coding, denials, and/or TES CM edits.
· Responsible for charge reconciliation of inpatient, outpatient, and/or outreach services. Utilize IDX standard reports, pending charge reports, scheduling and registration, or other data as applicable to research potential missed billing opportunities. Must meet established departmental goals related to reconciliation.
· Research and correct claims manager edits, CE edits daily by applying coding and carrier specific guidelines while maintaining compliance initiatives. Must meet departmental goals related to TES/CM edit resolution.
· Research and correct request log items daily by applying coding and carrier specific guidelines while maintaining compliance initiatives. Must meet departmental goals related to resolution of request log items.
· Monitor CMS and specialty society websites and research industry publications for coding and regulatory updates to continuously enhance coding and regulatory knowledge base. Communicate pertinent information to departments and providers.
· Efficiently perform data entry of professional charges on a daily basis as outlined in the departmental workgroup goals. Key all applicable data valued on charge tickets into the IDX billing system and with a high degree of accuracy.
· Process and send completed keyed batches to Parkshore daily. Must meet established departmental goals related to productivity.
· Provide coding coverage to other specialties, departments, divisions, and/or units as required.
· Attend billing educational sessions to enhance coding knowledge i.e.: American Academy of Professional Coders, Palmetto Professional Coder’s Association, UMA Compliance proficiency training, specialty seminars.
· All other duties as assigned.
Additional Job Description
Required Education and Work Experience:
CPC certification with 2 years directly related coding experience required. Extensive knowledge of ICD-10, CPT, HCPCS coding, medical terminology, federal and state regulatory guidelines and third party payer requirements required. Accuracy and attention to detail imperative. Ability to interact well with others at all levels with a flexible, energetic, proactive and positive style. Ability to multi-task and prioritize. Weekend work may be required.
Required Licensures, Registrations, Certifications:
Continuous requirements are to perform job functions while standing, walking and sitting. Ability to bend at the waist, kneel, climb stairs, reach in all directions, fully use both hands and legs, possess good finger dexterity, perform repetitive motions with hands/wrists/elbows and shoulders, reach in all directions. Maintain 20/40 vision corrected, see and recognize objects close at hand and at a distance, work in a latex safe environment and work indoors. Frequently lift and/or carry objects weighing 20 lbs (+/-) unassisted. Lift from 36” to overhead 15 lbs. Infrequently work in dusty areas and confined/cramped spaces.
If you like working with energetic enthusiastic individuals, you will enjoy your career with us!
The Medical University of South Carolina is an Equal Opportunity Employer. MUSC does not discriminate on the basis of race, color, religion or belief, age, sex, national origin, gender identity, sexual orientation, disability, protected veteran status, family or parental status, or any other status protected by state laws and/or federal regulations. All qualified applicants are encouraged to apply and will receive consideration for employment based upon applicable qualifications, merit and business need.
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