Patient Account Coder

DISTINGUISHING FEATURES OF THE CLASS: This position is responsible to code conditions and procedures as documented by clinics using the appropriate classification system as well as deal with patients and/or relatives regarding the nonmedical aspect of hospitalization related to payment for care and treatment. Employees of this class perform a wide variety of duties in maintaining cooperative relationships with patients and their families and in facilitating payment for hospital care and services.  The work is performed under the general direction of the Patient Accounts Manager with considerable leeway granted for the exercise of independent judgment in dealing with individual patients under established policy guidelines. Does related work as required.

TYPICAL WORK ACTIVITIES:

• Codes and submits claims, ensuring codes are accurate and sequenced correctly in accordance with government and insurance regulations;
• Follow up with providers on any documentation that is insufficient or unclear and communicate with the other clerical staff regarding documentation;
• Search for information in cases where coding is complex or unusual;
• Review the previous day’s batch of patient notes for evaluation and coding;
• Ensure that all codes are current and active;
• Contacts self-pay patients during hospitalization to answer questions regarding costs and billing and discuss financial arrangements for treatment and care;
• Arranges for payment by self-pay patients in accordance with established guidelines;
• Advises patients and their families regarding available financial benefits and resources available;
• Collects on delinquent accounts by establishing payment arrangements with patients; monitoring payments and following up with patients when payment lapses occur; Submits claims electronically and/or paper to the patient’s insurance carrier for both primary and secondary claims;
• Accesses various internet websites to determine claim eligibility status, third party regulations, updates, newsletters, etc.;
• Contacts third party payers when payment is not made within a reasonable time after billing and follows-up on claim rejections and submits corrected claims as needed;
• Contacts insurance carriers, employers, and governmental agencies to verify insurance coverage or eligibility for benefits;
• Works closely with the Department of Social Services to report spend-down balances and status of pending Medicaid applications;
• Performs appropriate documentation and follow-up when incorrect or denied payments are received;
• Receives patient payments, records payments on patient account, and reconciles patient’s account after payments and adjustments have been applied;
• Reconciles aged patient accounts and insurance accounts and follows-up on outstanding balances under established department policies and payer contracts;
• Checks final bill for accuracy and bills patients for services, keeping an electronic record of bills issued, payments received, or contracts established for payment arrangements;
• Refers delinquent accounts to collection agencies and reconciles reports and payments to and from the collection agency;
• Offers charity care assistance for all patients who meet the established guidelines and applies charity care adjustments to hospital accounts and notifies all other providers of discount applied;
• Maintains Personal Incident Account (PIA) for the nursing home residents to access their personal funds;
• Sorts and files correspondence and performs miscellaneous clerical duties including answering phones, correspondence, writing appeal letters for denials on claims, photocopying, daily mail and ordering office supplies;
• Maintains quality results by following standards;
• Maintains work operations by following policies and procedures and reporting compliance issues to the appropriate personnel;
• Reports any patient care or billing complaints to the compliance officer.

FULL PERFORMANCE KNOWLEDGE, SKILLS, ABILITIES AND PERSONAL CHARACTERISTICS:

Good knowledge of office terminology, procedures and equipment; working knowledge of official coding guidelines; good knowledge of business arithmetic; ability to understand and code medical records; ability to understand follow oral and written instructions; ability to operate a personal computer and use common office software programs; clerical ability; ability to establish and maintain cooperative relationships with others; ability to perform at a high level of accuracy; and ability to understand and apply relevant legal concepts regarding confidentiality and compliance.

MINIMUM QUALIFICATIONS: Graduation from high school or possession of an equivalency diploma and either:

1. Certification through the American Health Information Management Association (AHIMA) or the American Academy of Professional Coders

(AAPC) and one year clinic coding experience; or

1. Two years of full-time paid experience in the preparation and maintenance of medical records in a healthcare setting which involved coding and indexing of medical procedures; filing and maintenance of health facility medical records; analysis and evaluation of medical records; and electronic health facility medical records use; or
2. An equivalent combination of training and experience as defined by the limits of (A) and (B) above.