This is a description of a Staff Position Classification. It is not an announcement of a position opening. To view descriptions of current openings, please go to UNMJobs and Search Postings to view positions that are currently accepting applications.
The following statements are intended to describe, in broad terms, the general functions and responsibility levels characteristic of positions assigned to this classification. They should not be viewed as an exhaustive list of the specific duties and prerequisites applicable to individual positions that have been so classified.
Coordinates the processing of fees for professional services provided to patients, including those from assigned client components. Uses knowledge of multiple coding systems and procedures to analyze patient medical records and determine billable charges, and assigns national-standard codes to medical diagnoses and procedures. Analyzes complex medical records to ensure that medical billing conforms to legal and procedural requirements, and advises providers regardng billing and documentation policies and procedures. Assists in training and supports the activities of new and/or lower level Medical Coding Analysts, as appropriate to the position. Reviews, develops, and/or modifies procedures, systems, and protocols to achieve and maintain compatibility with established billing requirements.
Duties and Responsibilities
Reviews, develops, modifies, and/or adapts relevant client procedures, protocols, and data management systems to coordinate these with UNM methodology, to ensure that client billing operations meet the joint requirements of both the local facility and UPA.
Analyzes and interprets patients' medical records to identify and determine amount and nature of billable services; assigns and sequences appropriate diagnostic/procedure billing codes, in compliance with third party payer requirements, contractual arrangements, and protocols.
Advises and instructs providers regarding billing and documentation policies, procedures, and regulations; interacts with providers regarding conflicting, ambiguous, or non-specific medical documentation, to obtain clarification.
Trains and/or provides backup to lower level Medical Coding Analysts as appropriate to workload requirements and contractual commitments.
Monitors billing performances to ensure optimal reimbursement while adhering to regulations prohibiting unbundling and other questionable practices; prepares periodic reports for clinical staff identifying unbilled charges due to inadequate documentation.
Interacts with department heads and other administrative staff regarding implementation of new codes and revision of charge documents.
Monitors external data sources to ensure receipt and analysis of all charges.
Researches inquiries from providers and patients about fees, reimbursements, and denials.
Ensures strict confidentiality of financial records.
Follows established departmental policies, procedures, and objectives, continuous quality improvement objectives, and safety and environmental standards.
Attends coding conferences, workshops, and in-house sessions to receive updated coding information and changes in coding and/or regulations.
Performs miscellaneous job-related duties as assigned.
Minimum Job Requirements
High school diploma or GED; at least 3 years of experience directly related to the duties and responsibilities specified.
Certification in CCS, CCS-P, RHIA, RHIT, CPC, or specialty coding.
Completed degree(s) from an accredited institution that are above the minimum education requirement may be substituted for experience on a year for year basis.
Knowledge, Skills and Abilities Required
Ability to adapt and modify medical billing procedures, protocol, and data management systems to meet specific operating requirements.
Ability to gather data, compile information, and prepare reports.
Knowledge of auditing concepts and principles.
Ability to communicate effectively, both orally and in writing.
Knowledge of legal and policy constraints pertaining to patient billing.
Advanced knowledge of medical coding and billing systems and regulatory requirements.
Ability to maintain quality and safety standards.
Ability to use independent judgment and to manage and impart confidential information.
Ability to analyze complex medical records and identify billable services.
Advanced knowledge of medical terminology, anatomy, and physiology.
Ability to analyze and solve problems.
Knowledge of current and devleloping issues and trends in medical coding procedures requirements.
Ability to clearly communicate medical information to professional practitioners and/or the general public.
Ability to communicate technical information to non-technical personnel.
Ability to provide training, guidance, and operational support to lower level staff within area of specialty.
Position requires: a) analysis and interpretation of both UNM and non-UNM client component medical records; b) analysis of complex medical records, to include operating room surgical procedure reports or other highly technical medical diagnostic/procedural documentation; c) independent interaction with administrative and clinical staff regarding implementation/revision of complex new codes and charge documents; d) training and/or technical/operational guidance of new and/or lower level coding analysts.
Conditions of Employment
Must maintain certification status.
Working Conditions and Physical Effort
No or very limited physical effort required.
No or very limited exposure to physical risk.
Work is normally performed in a typical interior/office work environment.
The University of New Mexico provides all training required by OSHA to ensure employee safety.