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Under general direction, provides departmental expertise for coding and compliance issues to ensure compliance with current coding and billing regulations; supervises billing and coding staff; trains providers and staff in matters related to coding compliance.
Extensive knowledge of Pathology billing, reimbursement and third-party regulations
Knowledge of University and healthcare governing agency policies and procedures
Knowledge of medical and specific knowledge of pathology terminology
Interpersonal/human relations skills
Verbal and written communication skills
Planning and organizational skills
Ability code procedures and diagnose using appropriate CPT, ICD-9 and ICD-10 coding, including an understanding of Correct Coding Initiative issues as they relate to Pathology
Ability to interpret accounts and records and develop spreadsheets and reports
Ability to perform basic bookkeeping and compile statistics
Ability to extract accurate data from conversations and documents
Commitment to and ability to maintain confidentiality
Associates degree in a related field; supplemented with at least five (5) years of related work experience; must possess current certification as a certified medical coder.
Monitors billing procedures and documentation to ensure correct and compliant billing of Pathology procedures and professional interpretations; provides updates regarding reimbursement and regulatory compliance; conducts periodic audits of technical and professional billing for compliance and accuracy; maintains files; maintains resource library related to Pathology coding and billing regulations and compliance; ensures that Laboratory Information System (LIS) billing reflects current CPT and diagnosis code changes and billing compliance regulations, including working with the department labs to build and maintain appropriate procedure panels and fee schedules. This position provides in-house coding expertise to develop procedure panels to ensure accurate coding and billing. In addition, this position will work closely with the Practice Management Organization to ensure that codes are assigned and entered properly into the GE/IDX billing system so that accurate bills are efficiently and accurately submitted to payors.
Supervises, hires, orients, and evaluates billing staff; assigns work; develops work scheduels; instructs staff in proper billing procedures; assists with development and revision of departmental billing processes/procedures; monitors staff performance and provides feedback; ensures staff is obtaining adequate billing information; provides opportunity for associated billing training for staff. Must remain up-to-date on all coding changes and provide education on the content of the changes, evaluate how changes will impact current billing and clinical builds in the LIS and make recommendations for any needed remediation.
Assigns accurate billing codes; assists faculty and staff to ensure accurate documentation to support appropriate codes; selects appropriate account for charge entry; posts charges; verifies billing from reports and other source documents; ensures reconciliation of revenues and charges; maintains statistics; prepares charge and billing reports.
Reviews and follow-up on denials and reimbursement relative to coding and charge entry processes to maximize cash flow, reimbursement, and to assure regulatory compliance; provides assistance with revenue projections.
Participates in SLUCare faculty credentialing and hospital privileging when appropriate.
Performs other duties as assigned.
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