Medical Coding Analyst
Company: Adelante
Location: Phoenix
Posted on: May 27, 2023
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Job Description:
Medical Coding Analyst
Job Details
Job Location
Adelante Healthcare Center Support Office - Phoenix, AZ
Description
POSITION SUMMARY
Under direct supervision of the Training and Development Director,
performs audits of medical claims for compliance with federal
coding regulation and guidelines. This position also reviews and
resolves coding issues related to billing; researches complex
coding issues and participates in process improvements related to
coding and EM management. This position will also provide education
to providers and staff on correct documentation, coding, and
billing of visits.
EXPECTATIONS
Every Adelante employee will strive to maximize their performance
and contribution to Adelante Healthcare and the community we serve
every day. Employees are expected work in a manner that
demonstrates a commitment to quality, patient safety, employee
engagement, innovation, and the highest standards of personal
integrity, professionalism and competence.
OUR CORE VALUES
Excellence
Integrity
Sustainability
Respect
Compassion
Learning
Qualifications
ESSENTIAL SKILLS AND EXPERIENCE
Associates degree preferred
High school diploma or GED from an accredited institution
Coding certification through an accredited organization, including
Certified Coding Specialist (CCS) through AHIMA or Certified
Professional Coder (CPC) AAPC required
Detailed knowledge of medical coding systems, procedures, and
documentation requirements
Five (5) years of coding experience with a focus on E/M Coding and
OBGYN preferred
Highly effective written and verbal communication skills
Ability to provide guidance and training to professional and
technical staff in area of expertise
Ability to analyze and solve problems
Knowledge of legal, regulatory, and policy compliance issues
related to medical coding and billing procedures and
documentation
Knowledge of current and developing issues and trends in medical
coding procedures requirements
Ability to adapt and modify medical billing procedures, protocol,
and data management systems to meet specific operating
requirements
Valid Level One Fingerprint Clearance Card issued by the Arizona
Department of Public Safety for all specialty behavioral health
locations
The qualifications listed above are intended to represent the
minimum skills and experience levels associated with performing the
duties and responsibilities contained in this job description. The
qualifications should not be viewed as expressing absolute
employment or promotional standards, but as general guidelines that
should be considered along with other job related selection or
promotional criteria.
POSITION REPONSIBILITIES/ESSENTIAL
EXPECTATIONS
Ensuring that charges are being captured, documented, and billed in
accordance with policies and procedures as well as payer
regulations and CPT/ICD-10 guidelines
Review pending charges for submission to ensure accuracy of the
billing, make approved changes where necessary, or return to the
provider to correct the claim prior to billing to the plans
Proactively identify areas of opportunity to improve the charge
capture processes to meet compliance regulations and maximize
revenue
Collaborate with the Revenue Cycle Director to implement a chart
audit process to ensure charges are being documented, captured and
billed so that training can be provided to staff
Present audit findings and action items to Revenue Cycle Director
to improve the charge capture and billing process
Meet individually or with a group of providers to educate and train
on compliant coding practices based on chart review findings
Prepare and create training materials and conducts periodic
education and training sessions with providers and coding staff on
medical coding and documentation requirements
May provide guidance to coders
Delegate workload to staff, ensure charges are being regularly
reviewed, corrected, and submitted timely
Train and instruct medical coders and providers on appropriate
coding practices in accordance with payer and regulatory
requirements
Research, analyze, and respond to inquiries regarding coding,
documentation, denials, and billing
Remain current with industry changes and ensure all staff are
educated on such changes
Interacts with providers and management to review and/or implement
codes and to update charge documents
Additional Duties and Responsibilities
PCMH
All employees are responsible for promoting and participating in
interdisciplinary communication and collaboration to enhance the
delivery of quality across the health care system. Employees should
maintain an environment which supports and engages patients and
co-workers in a caring team based model to promote wellness and
improve health outcomes.
Adherence to Compliance and Code of Conduct
All employees are required to comply with Adelante Healthcares
written standards, including its Compliance Program and Standards
of Conduct, policies and procedures and reporting of any conduct
that potentially violates Adelantes legal or compliance
requirements. Such compliance will be an element considered as part
of the regular performance evaluation.
PHYSICAL DEMANDS AND WORK ENVIRONMENT
The physical demands and work environment characteristics described
here are representative of those that must be met by an employee to
successfully perform the essential functions of this job.
Reasonable accommodations may be made to enable individuals with
disabilities to perform the essential functions.
Physical demands: While performing the duties of this job, the
employee may be required to sit for long periods of time, is
required to stand, walk, use hands to handle or feel objects, tools
or controls; reach with hands and arms; climb steps/stairs;
balance; stoop, kneel, crouch or crawl; talk or hear; smell; manage
stress as it relates to essential job functions. The employee must
frequently lift and/or move up to 25 pounds without assistance, and
may occasionally be required to lift or move up to 50 pounds with
assistance. Specific vision abilities
required by the job include close vision, distance vision, color
vision, peripheral vision, depth perception, and the ability to
adjust focus.
Work environment: While performing the duties of this job, the
employee is exposed to weather conditions prevalent at the time
when traveling to various clinic sites. The noise level in the work
environment is usually moderate. The employee may be subject to
health hazards (contagious diseases, blood borne pathogens, etc.)
when working in the clinic area.
Job-related Information Check a Response
Safety Sensitive Position
Yes or No
Merit Increase Eligible
Yes or No
Telework Eligible
Yes or No
CPR/BLS Required
Yes or No
Level One Fingerprint Clearance Required
Yes or No
Level One Fingerprint Clearance Required
Specialty Behavioral Health Location
Yes or No
Annual Fitness for Duty Required
Yes or No
Fit Test Required
Yes or No
Credentialing Required
Yes or No
Use of Adelante Healthcare Vehicles
Yes or No
In any organization or job, changes take place over time. Although
an effort will be made to keep job-related information current,
this is not an all-inclusive list of job responsibilities. Adelante
Healthcare, Inc. reserves the right to revise or change job duties
and responsibilities as the business need arises. In compliance
withEEOC 29 CFR part 1630, if the essential functions of this
position cannot be performed in a satisfactory manner by the
employee, further accommodations shall be made if it does not
constitute undue hardships upon this organization .
Keywords: Adelante, Phoenix , Medical Coding Analyst, Professions , Phoenix, Arizona
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