Performs complex specialty or multi-clinical coding and auditing functions of physician charges in accordance with departmental guidelines and governmental regulations.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
Audits records to ensure proper coding of services prior to billing on pre-determined selected charges.
Accurately follows coding guidelines and legal requirements to ensure compliance with federal and state regulatory bodies.
Monitor compliance standards in accordance with the Compliance policies and the Code of Conduct. Reports compliance problems appropriately.
Determines if final diagnoses and procedures stated by the physician or other health care providers are valid and complete.
Qualitative analysis - Evaluates the medical record for documentation consistency and adequacy. Ensures that the final diagnosis accurately reflects the care and treatment rendered. Reviews the records for compliance with established reimbursement and special screening criteria.
Qualitative analysis - Evaluates the medical record for proper documentation for Medicaid HEDIS measurements and proper HEDIS coding to maximize HEDIS bonus payment.
Analyzes provider documentation to ensure the appropriate Evaluation & Management (E&M) levels are assigned using the correct CPT code.
Educate and offer feedback to physicians and staff as needed to ensure that documentation is complete, accurate, and compliant with guidelines.
Provide coding training for onboarding medical and billing staff.
Generate monthly coding error report for each provider. Report is due on the 5th of each month to the Director of Revenue Cycle, Chief Medical Officer and to the Director of Clinical Quality Management.
Maintain coding knowledge and skills through continuing education activities and the review of pertinent literature, and attend institutional coding meetings, AHIMA or AAPC seminars, or other educational forums.
Bachelor’s degree in Health Information Management and a Medical Coding certification from American Academy of Professional Coders (AAPC) preferred and/or Associate Degree in Health Information Management with AAPC certification and 5 year of coding experience in outpatient coding.
Three years’ experience on coding outpatient office visit for Pediatric, Adult and Prenatal services.
For more than 100 years, Infant Welfare Society of Chicago (IWS) has pioneered innovative healthcare practices in treating Chicago’s most vulnerable populations. It began as a series of “milk stations” to provide nutritional support to combat high rates of infant mortality. In 1924, it incorporated child development and behavioral health counseling, and since 1970, it has provided pediatric dentis...try services. Orthodontic care was introduced in 1991, pediatric optometry in 1995, and speech, occupational and vision therapies began in 2015. In 2005, IWS opened the doors of the Angel Harvey Family Health Center in a beautiful 42,000 square foot LEED Silver certified building. In doing so, we created a healthcare home where quality care is provided to everyone who enters our center.
What we do:
The Angel Harvey Family Health Center is a full-service community-based clinic that offers a broad spectrum of medical, dental, optometry, behavioral health and child development services under one roof. This "one-stop-shop" ensures barrier-free access and provides a multi-service healthcare home for children and families in Chicago and the surrounding areas.