GBMC HealthCare · 17 hours ago
Coding Data Quality and Patient Accounts Specialist
Baltimore, MD
Full-time
Onsite
Entry, Mid Level
$27.32/hr - $44.80/hr
2+ years expGBMC HealthCare is a healthcare provider seeking a Coding Data Quality and Patient Accounts Specialist. This role involves coding chemotherapy and infusion therapy regimens, ensuring compliance with guidelines, and managing patient accounts and insurance claims.
HealthcareHealth Care
Responsibilities
Resolves patient and insurance carrier complaints. Provides a timely response to all patient billing inquiries. Responds to all inquiries in a courteous, professional manner with a willingness to listen and understand the problem
Collects, reviews and approves deposits daily. Deposits are taken to the cashier daily. Copies of deposit slips and daily logs are maintained for future reference
Resolves emails from GBMA & GBMC regarding various patient account issues. Researches and resolves documentation requests regarding referrals and authorizations. Contacts insurance companies, patients and primary care providers to obtain appropriate information regarding referrals and benefits
Educates the front office staff in understanding the process of obtaining precertification and/or referrals, and collecting copays and deductibles from patients at the time of services. Keeps staff informed regarding CPT/ICD-10 coding changes and guidelines
Spends more than 80% of each day coding and abstracting documentation for chemotherapy services, office visits, and surgical procedures. Works with staff and physicians in various areas of Oncology to ensure an understanding of coding and documentation guidelines
Clarifies documentation issues with medical staff. Trains clinical staff on appropriate documentation requirements and billing for services (hydration services, chemotherapy, injections, etc)
Codes diagnoses and operations of a complex nature in accordance with CPT/ICD-10. Contacts physicians to obtain clarification of diagnoses and/or operative procedures when necessary
Relays information to other hospital personnel in the Medical Center that may affect procedures relating to billing, reimbursement or statistics. Works closely with Quest, LabCorp and the GBMC lab regarding ICD-10 codes as related to revenue collection
Educates physicians on the need for medical necessity diagnosis codes for all drugs
Develops a mechanism to add new ICD-10 codes to charges if there are changes after initial registration; appends appropriate diagnosis codes to all new orders. Ensures accuracy of chemotherapy orders by comparing orders to NCCN guidelines and advises physician of possible payment issues. Advises patient of non-coverage issues, as appropriate
Audits 100% of Infusion Therapy’s daily charges; and reconciles services rendered to services billed
Audits more than 50% of Medical Oncology E/M charges
Works closely with authorization staff
May audit 100% of Breast Center and Surgical Oncology surgeries
Codes and authorizes all genetic/molecular testing ordered. Relays authorization/payment issues to providers and patients
Assists patients in applying for financial assistance through outside laboratories when appropriate
Works closely with the infusion center pharmacy to ensure all drug billing requirements are met
Qualification
Required
Specialized training and/or knowledge of coding/abstracting procedures, anatomy and physiology, and medical terminology
At least 2 years of progressive medical billing experience to include customer service
1 year of CPT and ICD-10 coding experience
Knowledge of anatomy and physiology, medical terminology, and ICD-10 and CPT coding
Skill in written and oral communication
Skill in using computers and personal productivity applications
Knowledge and understanding of third party insurers
Skill in using effective customer service techniques
Skill in data research, analysis and interpretation
AAPC or AHIMA coding certification required within 12 months of position acceptance
Preferred
AAPC or AHIMA coding certification
1 year of CPT and ICD-10 coding experience
Company
GBMC HealthCare
GBMC HealthCare, Inc.
1001-5000 employees
Funding
Current Stage
Late StageLeadership Team
John Chessare MD
President & CEO
Stacey McGreevy
Chief Operating Officer
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