Primary Health Solutions

• Responsible for entering/auditing/coding patient services to ensure encounters transfer properly for submission to insurance payers. • Analyze coding related claim issues, process gaps and denials to trend feedback for providers by location and/or specialty. • Review provider documentation (including hospital procedures) and translate services into correct codes. • Append payer specific modifiers and claim criteria when applicable. • Review incomplete encounters and code based on available documentation in EHR systems. • Know and understand several different coding systems, including ICD-10-CM, ICD-10-PCS, CPT, Level 1 HCPCS and Level 2 HCPCS. • Use computers / billing software to create and bill encounters that generate clean claims. • Attend internal meetings relevant to EHR workflows and share best coding practices. • Assist Operations when coding guidance is requested for existing or new services. • Understand payer reimbursement and PPS visit qualification for Medicare and Medicaid. • Trend areas of focus where provider training or re-training is needed. • Monitor, trend and resolve tasks related to coding edits, rejections, and denials. • Communicate with providers, patients, and insurance payers. • Review patient accounts and correct any missing or inaccurate information. • Investigate and appeal claims that were denied incorrectly. • Complete coding projects such as quarterly or ad hoc provider chart audits. • Adapt to updates and changes in billing software. • Perform all other duties and tasks as assigned.