The coder, complimented with clinical knowledge and understanding of the complexity of a Federally Qualified Health Center (FQHC) entity and its workflow, enhances the potential to prevent loss of revenue, optimize charge capture, and adhere to compliance issues. Assign and sequence diagnostic and procedural codes for for all service lines for data retrieval, billing, and reimbursement. Documentation, assessment and review for accurate abstracting of clinical data to meet regulatory and compliance requirements. Acts as subject matter expert on all FQHC related coding regulations and keep current on any federal, state or plan specific changes or updates. Provide training and education as needed/requested. Assist Manager with assigned special projects.
Review all charges, ensure accurate charge capture and review medical necessity. Proactively communicate with providers, nursing staff and other clinical personnel to insure adequate documentation to support charges.
Reviews bills and payments to insure correctness. Audits, corrects and submits any denials as appropriate. Effective use of software to follow through on accuracy of claim submission. Appropriately seeks assistance from Manager.
Verify accuracy of patient account/type and demographic data and coordinates corrections to assure accurate billing/reimbursement and reporting.
Actively engages in any revenue cycle audit or chart review. Devise best practice for documentation retrieval and collection. Educate clinic staff as required.
Participate in communication and education to Medical Staff/Clinical Staff concerning documentation issues to support accurate coding and billing. Shares information in a professional and timely manner.
Participate in process to evaluate and build charges for new procedures. Provide education and instruction to staff members across service lines regarding charging, coding, and reimbursement. Interacts with providers and staff providing technical support, training, and guidance.
Assists in coordination of the compilation of data relative to regulatory agencies and the accreditation process.
Participates in continuing education activities to enhance knowledge, skills and keep credentials current
Displays initiative and supports Continuous Quality Improvement efforts and performs special projects, training, education, and/or other duties as assigned by Manager.
Performs other duties as assigned.