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TMH Physician Organization (Texas Medical Center)

Applies correct coding conventions to patient charge encounters in a clinical environment. Responsible for abstracting diagnosis from physician's records and performs quality assurance and oversight to junior coders. Within clinical department may also be responsible for collections of payments.

DUTIES AND RESPONSIBILITIES
Coding:
Using ICD-9 standards, codes and abstracts medical records for reimbursement purposes from patient charts, physician documentation, medical diagnostic and /or interventional reports.
Reviews individual medical records to verify and substantiate diagnosis and procedures.
Matches charge documents to appropriate billing sheets, operative reports, and medical records to ensure correct codes are applied and all billable procedures are captured.
Ensures patients are charged for all procedures via encounter form.
Code clinical visits, surgery charges and laboratory procedures.
Communicates with physicians to obtain or clarify diagnosis.
Batch daily charges
Responds to or clarifies internal requests for medical information.
Performs QA and oversight to junior coders.
Provides education to physicians' records.
Communicates regularly with physicians and physician office staff on accurately coding diagnosis and procedures.

Collections:
Verifies accuracy of claim forms for correct diagnosis and procedure order, service dates, place of service, etc.
Submit claims to appropriate primary and secondary payers.
Expedite and maximize payment of claims by contacting 3rd party payers and patients.
Investigate and appeal unpaid and partially paid claims by 3rd party payers.
Negotiate payments with insurance companies for out-of-network patients.
Identify accounts for advanced due diligence or legal placement in accordance with CCMC's Account Documentation policy and procedures.
Accountable for ongoing professional growth and development
Maintains strict confidentiality of patients, employees and hospital information at all times.
Performs other duties as assigned

EDUCATION REQUIREMENTS
High School Diploma required
Associates degree in HIM preferred.

EXPERIENCE REQUIREMENTS
Minimum 5 years of coding experience, including 2 years as a certified coder.

CERTIFICATES, LICENSES AND REGISTRATIONS REQUIRED
Certified Procedural Coder (CPC) required.