RESPONSIBILITIES AND DUTIES
Evaluates medical record documentation and coding to optimize reimbursement by ensuring that diagnostic and procedural codes and other documentation accurately reflect and support the outpatient visit, and ensures that data complies with legal standards and guidelines.
Interprets medical information such diagnostic descriptions and procedures for a given visit in order to accurately assign and sequence the correct billing codes; places ICD (International Classification of Diseases) codes on all Medi-Cal and Medicare claims.
Reviews Medi-Cal and Medicare reimbursement claims before submission for completeness and accuracy and to minimize claim denial.
Evaluates records and prepares reports for review by management and/or professional evaluation committees.
Makes recommendations for changes in policies and procedures relating to assigned tasks; assists data processing staff in making revisions to the computer master file as required.
Analyzes and uses correct modifiers to increase reimbursement amounts.
Provides technical guidance to physicians and other departmental staff related to billing assignments, in identifying and resolving issues or errors; educates and advises staff on proper code selection, documentation, procedures, and requirements.
Reviews bulletins, newsletters, and periodicals, and attends workshops to stay abreast of current issues, trends, and changes in the laws and regulations governing medical record coding and documentation; develops and updates procedures manuals to maintain standards for correct coding, minimize the risk of fraud and abuse, and optimize revenue recovery.
Performs end of month billing processes for Medi-Cal and or Medicare claiming for state and federal reimbursement, and third party billing.
Performs related duties as required.
Careers In Government