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Duties/Responsibilities:
Evaluates medical record documentation and charge-ticket coding to optimize reimbursement by ensuring that diagnostic and procedural codes and other documentation accurately reflects and supports outpatient visits and to ensure that data complies with legal standards and guidelines.
Interprets medical information such as diseases or symptoms and diagnostic descriptions and procedures to accurately assign and sequence the correct ICD-9-CM and CPT codes.
Reviews state and federal Medicare reimbursement claims for completeness and accuracy before submission to minimize claim denial.
Evaluates records and prepares reports on such topics as the number of denied claims or documentation or coding issues for review by management and/or professional evaluation committees.
Makes recommendations for changes in policies and procedures; works with data processing staff to revise the computer master file. Develops and updates procedures manuals to maintain standards for correct coding, to minimize the risk of fraud and abuse, and to optimize revenue recovery.
Provides technical guidance to physicians and other staff in identifying and resolving issues or errors such as incomplete or missing records and documentation, ambiguous or nonspecific documentation, and/or codes that do not conform to approved coding principles/guidelines.

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