Conduct internal audits of hospital bills to ensure minimal revenue loss and educate personnel on clinical reimbursement practices. Manage the denial and appeal process by researching medical records and coordinating with third-party payers.
The specialist is responsible for assigning accurate ICD-10 and CPT-4 codes to complex outpatient medical records to ensure proper reimbursement and regulatory compliance. They also monitor coding quality and productivity while communicating with various departments to resolve billing and registration issues.
The role involves auditing inpatient and outpatient encounters to ensure accurate reimbursement and compliance with federal and state regulations. The auditor serves as a subject matter expert, providing training and guidance to coding specialists while collaborating with clinical documentation staff.
Accurately code complex hospital inpatient accounts for reimbursement and compliance using ICD-10-CM/PCS systems. Collaborate with clinical staff and CDI specialists to resolve documentation issues and ensure coding quality and productivity standards are met.
