Summary

Coordinates the processing of fees for professional services provided to patients within a specified group of clinical areas, for the purpose of reimbursement. Analyzes patient medical records to assure that documentation by providers conforms to legal and procedural requirements. Assigns specified codes to medical diagnoses and/or clinical procedures. Interacts with physicians and other providers regarding billing and documentation policies and procedures.

Duties and Responsibilities

1. Analyzes and interprets patient medical records to identify and determine amount and nature of billable services; assigns and sequences appropriate diagnostic/procedure billing codes in compliance with requirements of third party payor requirements.
2. Interacts with physicians and other patient care providers regarding billing and documentation policies, procedures, and regulations; obtains clarification of conflicting, ambiguous, or non-specific documentation.
3. 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.
4. Interacts with department heads and other administrative staff regarding implementation of new codes and revision of charge documents.
5. Researches inquiries from providers and patients about fees, reimbursements, and denials.
6. Monitors external data sources to ensure receipt and analysis of all charges.
7. Ensures strict confidentiality of financial and medical records.
8. Follows established departmental policies, procedures, and objectives, continuous quality improvement objectives, and safety and environmental standards.
9. Attends coding conferences, workshops, and in-house sessions to receive updated coding information and changes in coding and/or regulations.
10. Performs miscellaneous job-related duties as assigned.

Minimum Job Requirements

• High school diploma or GED; at least 1 year of experience directly related to the duties and responsibilities specified.
• 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

• Knowledge of legal and policy constraints pertaining to patient billing.
• Ability to communicate effectively, both orally and in writing.
• Ability to gather data, compile information, and prepare reports.
• Knowledge of auditing concepts and principles.
• Knowledge of medical terminology.
• Ability to analyze complex medical records and identify billable services.
• Ability to use independent judgment and to manage and impart confidential information.
• Ability to maintain quality and safety standards.
• Ability to analyze and solve problems.
• Knowledge of current and devleloping issues and trends in medical coding procedures requirements.
• Knowledge of patient care charts and patient histories.
• Ability to clearly communicate medical information to professional practitioners and/or the general public.
• Knowledge of ICD-9, ICD-0 and/or CPT medical billing codes.
• Ability to communicate technical information to non-technical personnel.

Distinguishing Characteristics

Position requires: a) analysis and interpretation of patient medical records to identify and determine the amount and nature of billable services; b) utilization of ICD-9-CM and CPT coding principles in the assignment and sequencing of diagnostic and procedure billing codes; c) direct interaction with providers regarding medical documentation and billing concerns; d) utilization of current knowledge of third party payer documentation requirements; e) interaction with administrative staff regarding implementation of new codes and revision of charge documents; f) research, analysis, and resolution of inquiries from providers and patients regarding fees, reimbursements, and denials.

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.

Revised Date: 03/20/2017