Lead Coder for Family Medicine & Convenient Care- 100% Remote

1. Uses an appropriate problem-solving approach to plan services to support billing and collection efforts of all FHPG Family Care Centers and Convenient Care FH employed or contracted providers billing in under the FH umbrella.

a. Responsible for evaluating encounter sessions for accurate coding per CPT, CMS, Palmetto and payer requirements.

b. Responsible for maintaining workflow for Family Care and Convenient Care charge encounters and managing work low with Primary Care/Convenient Care Coder to drop charges from charge review status timely with minimal denials.

c. Identify errors in coding/billing that allows education to be presented back to Providers to prevent reimbursement loss and assist in educating providers on Medicare LCDs and payer requirements for specific lab orders as needed.

d. Analyze coding adjustments made to ascertain accuracy and validity. Determine and execute the best approach for denial resolution and processing appeals and communicating errors back to Revenue Integrity and Management to update edits in accordance with Federal, State and payer guidelines,

e. Ensure charges are filed timely and accurately.

f. Assist manager in identifying coding errors that generate denials and help to establish front end charge review edits to decrease denials.

g. Recognize trends in coding errors to notify Compliance for needs of additional Provider education.

h. Work with Revenue Integrity staff to identify reimbursement issues in Family Care and Convenient Care charges and notify Management.

i. Detailed knowledge of Annual Wellness Visit coding and billing and each payers’ requirements for optimal revenue and reimbursement.

j. Coding for minor surgical procedures done in Convenient Care Service Locations.

Education/formal training/licensure/certifications/experience:

Prefer bachelor’s degree in business, Healthcare Administration or Information Systems; experience may be accepted in lieu of education or formal training. Three years experience in physician group practice that utilizes EMR and Billing systems to perform daily activities. Greater than three years’ experience in Clinic Practices and Clinic Billing or Coding. Certification in Coding either CPC or CCA or CCS-P or COC or CEMC or CFPC preferred