Coding Data Quality and Patient Accounts Specialist

Under General Supervision

Under general supervision, collects data by abstracting, assessing, and analyzing demographic and clinical information. Spends greater than 50% of each day coding (CPT, HCPCS, and ICD-10) each new chemotherapy and infusion therapy regimen to ensure compliance with FDA and NCCN guidelines. Provides correct diagnosis and procedure codes to authorization staff to ensure insurance approval of services. Audits daily infusion therapy charges and educates nursing staff as appropriate. Routinely audits and educates physicians regarding evaluation and management, ICD-10 coding, and documentation requirements. Works assigned work queues in EPIC to correct coding, claims, and insurance discrepancies. Corrects ICD-10 coding errors for labs/procedures using local and national coverage determinations and educates providers if necessary. Manages denials and appeals to the insurance company as appropriate. Meets with patients and families to discuss financial requirements and insurance benefits regarding chemotherapy and infusion therapy. Assists authorization department with denials and arranges peer-to-peer review. Under limited supervision, is responsible for the day-to-day collection of past due accounts. Responsible for ensuring that front office personnel understand and follow the billing requirements of various insurance carriers. Monitors deposits daily. Fields all calls regarding billing and coding from patients, providers, and insurance companies. Has an understanding of global billing and educates providers and patients.

Position Summary

This position supports the department of medical oncology, the role is 100% in person in Towson, MD. Future remote work options may be available on a limited basis.

Education and Certification

Specialized training and/or knowledge of coding/abstracting procedures, anatomy and physiology, and medical terminology. AAPC or AHIMA coding certification preferred.

Experience

At least 2 years of progressive medical billing experience to include customer service; 1 year of CPT and ICD-10 coding experience preferred.

Skills and Knowledge

Knowledge of anatomy and physiology, medical terminology, and ICD-10 and CPT coding. Skill in written and oral communication. Skill in using computers and personal productivity applications. Knowledge and understanding of third-party insurers. Skill in data research, analysis, and interpretation.

Licensures and Certifications

Accreditation by AAPC or AHIMA preferred.

Principal Duties and Responsibilities

Resolves patient and insurance carrier complaints. Provides a timely response to all patient billing inquiries. Responds to all inquiries in a courteous, professional manner with a willingness to listen and understand the problem. Collects, reviews, and approves deposits daily. Deposits are taken to the cashier daily. Copies of deposit slips and daily logs are maintained for future reference.

Responsibilities

• Resolves emails from GBMA & GBMC regarding various patient account issues.
• Researches and resolves documentation requests regarding referrals and authorizations.
• Contacts insurance companies, patients, and primary care providers to obtain appropriate information regarding referrals and benefits.
• Educates the front office staff in understanding the process of obtaining precertification and/or referrals, and collecting copays and deductibles from patients at the time of services.
• Keeps staff informed regarding CPT/ICD-10 coding changes and guidelines.
• Spends more than 80% of each day coding and abstracting documentation for chemotherapy services, office visits, and surgical procedures.
• Works with staff and physicians in various areas of Oncology to ensure an understanding of coding and documentation guidelines.
• Clarifies documentation issues with medical staff.
• Trains clinical staff on appropriate documentation requirements and billing for services (hydration services, chemotherapy, injections, etc.).
• Codes diagnoses and operations of a complex nature in accordance with CPT/ICD-10.
• Contacts physicians to obtain clarification of diagnoses and/or operative procedures when necessary.
• Relays information to other hospital personnel in the Medical Center that may affect procedures relating to billing, reimbursement, or statistics.
• Works closely with Quest, LabCorp, and the GBMC lab regarding ICD-10 codes as related to revenue collection.
• Educates physicians on the need for medical necessity diagnosis codes for all drugs.
• Develops a mechanism to add new ICD-10 codes to charges if there are changes after initial registration; appends appropriate diagnosis codes to all new orders.
• Ensures accuracy of chemotherapy orders by comparing orders to NCCN guidelines and advises physician of possible payment issues.
• Advises patient of non-coverage issues, as appropriate.
• Audits 100% of Infusion Therapys daily charges; and reconciles services rendered to services billed.
• Audits more than 50% of Medical Oncology E/M charges.
• Works closely with authorization staff.
• May audit 100% of Breast Center and Surgical Oncology surgeries.
• Codes and authorizes all genetic/molecular testing ordered.
• Relays authorization/payment issues to providers and patients.
• Assists patients in applying for financial assistance through outside laboratories when appropriate.
• Works closely with the infusion center pharmacy to ensure all drug billing requirements are met.

Physical Requirements

Ability to sit, stand, walk, concentrate, and pay close attention to detail.

Working Conditions

Normal office environment with little exposure to excessive noise, dust, temperature, and the like.

Conditions of Employment

AAPC or AHIMA coding certification required within 12 months of position acceptance.

GBMC Values

GBMC Values:

• Respect: I will treat everyone with courtesy. I will foster a healing environment. Treats others with fairness, kindness, and respect for personal dignity and privacy. Listens and responds appropriately to others needs, feelings, and capabilities.
• Excellence: I will strive for superior performance in every aspect of my work. I will recognize and celebrate the accomplishments of others. Meets and/or exceeds customer expectations. Actively pursues learning and self-development. Pays attention to detail; follows through.
• Accountability: I will be professional in the way I act, look, and speak. I will take ownership to solve problems. Sets a positive, professional example for others. Takes ownership of problems and does what is needed to solve them. Appropriately plans and utilizes required resources for various job duties. Reports to work regularly and on time.
• Teamwork: I will be engaged and collaborative. I will keep people informed. Works cooperatively and collaboratively with others for the success of the team. Addresses and resolves conflict in a positive way. Seeks out the ideas of others to reach the best solutions. Acknowledges and celebrates the contribution of others.
• Ethical Behavior: I will always act with honesty and integrity. I will protect the patient. Demonstrates honesty, integrity, and good judgment. Respects the cultural, psychosocial, and spiritual needs of patients/families/coworkers.
• Results: I will set goals and measure outcomes that support organizational goals. I will give and accept help to achieve goals. Embraces change and improvement in the work environment. Continuously seeks to improve the quality of products/services. Displays flexibility in dealing with new situations or obstacles. Achieves results on time by focusing on priorities and manages time efficiently.

Pay Range

$27.32 - $44.80

Equal Employment Opportunity

GBMC HealthCare and its affiliates are Equal Opportunity employers. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity and expression, age, national origin, mental or physical disability, genetic information, veteran status, or any other status protected by federal, state, or local law.