1. Analyze and document all problems and resolutions to HVC Procedural services charging process 2. Develops and maintains a working knowledge of CPT coding, ICD 9/10 coding, DRG's and revenue contracts to ensure proper and effective charge capture is accomplished in HVC Procedural Services. 3. Develops working knowledge of all standard Hospital software products related

1. Researches payer denials related to medical necessity, coding, etc resulting in denials and delays in payment. 2. Evaluates Outpatient Clinical denials against medical record documentation, the coding of the encounter , payer policies and contracts, and coverage determinations to determine the viability of an appeal 3. Compiles the supporting documentation by working i

1. Collects, validates and accurately documents patient insurance and benefits information and is fully knowledgeable about all aspects of insurance verification requirements. 1.1 Utilizes the On line Eligibility system and/or other means (i.e. telephone, fax or various third party payer website) to obtain insurance benefits and makes sure insurance verification informati

1. Reviews medical record documentation to determine appropriate ICD 10 CM codes in accordance with official coding guidelines. 2. Reviews medical record documentation and accurately selects the appropriate CPT codes, modifiers, and ICD 10 PCS, when applicable, in accordance with official coding guidelines. This includes resolving CCI edits, as applicable. 3. Maintains a

1. Accurately prepares patient documentation for batch scanning into electronic record system. 1.1 Prepares patient documentation for scanning according to the date of discharge, or other criteria communicated by department leaders. 2. Scans documents into electronic document management system using a batch scanner. 2.1 Operates batch management software and batch scanner

1. Assisting in the ongoing updates of CPT and ICD10 Notifying physicians of changes within each specialty; evaluating procedure codes and diagnosis on an ongoing basis and recommending corrections and changes for continuous improvement; Reviewing coding guidelines for OP reports, Multi Specialty Surgeons, Physician Assistants, hospitalists and other departments; attendin

1. Follows department established Fax Review protocols. Extracts and summarizes pertinent clinical information to transmit to payors for reimbursement. 2. Proactively identifies potential concerns regarding clinical eligibility for admission and/or continued stay reviews and addresses with Care Coordination. 3. Coordinates reconsiderations and/or peer to peer reviews for