About Wilmington Health
Since 1971, Wilmington Health has been committed to the care and health of our community in Wilmington as well as all of Southeastern North Carolina. Wilmington Health is structured as a multi-specialty medical practice with primary care providers integrated into the system. In this way, Wilmington Health is able to provide a comprehensive and coordinated approach to the care of all our patients. Wilmington Health is committed to using collaborative, evidence-based medicine in providing the highest quality of care to the patients we serve.
Purpose:
Provide guidance and instruction regarding insurance coding protocol to ensure compliance with regulatory requirements.
Essential Duties/Responsibilities:
- Serve as a technical resource for all coding and billing regulations for provider services
- Assist in formulating policies and procedures regarding coding and billing to ensure consistency and compliance across all clinic departments
- Interact with medical staff and clinic staff to ensure quality and consistency with coding and billing policies
- Perform quality control reviews of internal audits
- Work with designated clinic administrative staff in identifying and addressing significant coding/billing issues. This may include initiating policy changes and/or identifying areas in need of corrective action plans and assist in development and execution of actions plans
- Educating and training of clinic staff and medical staff
- Review and update clinic fee schedule on an annual basis
- Review and update of encounter forms/charge tickets on an annual basis
- Perform Evaluation and Management (E/M) profiling on a monthly basis
Other Duties:
QUALIFICATIONS
- High school diploma or equivalency
Required:
- 3-5 years health insurance experience, Certified Coder
- CPC, CCS-P
Preferred:
- Abstract coding experience
Wilmington Health is an Equal Opportunity Employer committed to providing equal opportunities to all applicants and employees. We are committed to treating everyone equally and with respect regardless of race, age, sex, religion, national origin, citizenship, marital status, veteran’s status, sexual preference, disability, genetic information, or any other class protected under state or federal law.
ADA Physical Demands:
Rarely (Less than .5 hrs/day) Occasionally (0.6 – 2.5 hrs/day) Frequently (2.6 – 5.5 hrs/day) Continuously (5.6 – 8.0 hrs/day)
Physical Demand
Required?
Frequency
Standing
Rarely
Sitting
Frequently
Walking
Occasionally
Kneeling/Crouching
Lifting
Coding Specialist Competencies
General
- Customer Service
- Professionalism/Integrity/Responsibility
- Teamwork/Process Focus
- Dependability/Punctuality
- Interpersonal Relationships/Communication
- Judgment/Decision Making/Problem Solving
- Quality/Quantity
- Initiative
- Safety and Housekeeping
- Organizational Skills/Time Management
- Quality Management
- Cost Consciousness
- Motivation
- Innovation
Department Specific
- E/M audits monthly and review with physician
- PRM -- add new prices, make sure codes are updated annually; update ICD-9 file annually
- Update charge sheets annually and as needed
- Update Experior when patients re dismissed from practice or from individual physicians and talk to patients with questions
- Read monthly Medicare, Medicaid, and coding bulletins; update appropriate staff and physicians
- Be available to staff and providers for coding questions
- Special project audits--i.e., shared visit documentation, Medicare audit requests, patient complaint audits
Skills Required
- High school diploma or equivalent
- 3-5 years of health insurance experience
- Certified Coder
- CPC certification
- CCS-P certification
- Abstract coding experience
What We Do
Since 1971, Wilmington Health has been committed to the care and health of our community in Wilmington as well as all of Southeastern North Carolina. Wilmington Health is structured as a multi-specialty clinic with primary care providers integrated into the system. In this way, Wilmington Health is able to provide a comprehensive and coordinated approach to the care of all our patients. In 2013, Wilmington Health was named a 2013 Acclaim Award Honoree by the American Medical Group Association (AMGA). The prestigious honor is awarded annually to only three national healthcare organizations. Previous esteemed Acclaim Award Honorees include Mayo Clinic Health System, Johns Hopkins Medicine, and The Cleveland Clinic. Wilmington Health’s drive to become a High Performance Health System (HPHS) began over five years ago by taking a programmatic approach involving a three part system of change including direction setting by our leadership, process improvement at the ground level, and a redesign of the most elemental processes throughout the organization. A priority was given to paying careful attention to metrics, analysis, and critical assessment of each innovation and how these changes may affect the total cost of care. Only by understanding each of these aspects at work, was the organization able to pragmatically and intelligently design a future approach to the provision of healthcare. Additionally, Wilmington Health leadership began to put greater focus on creating a culture of change within the organization, understanding that this is the most powerful tool in any transformative process. Included were new and improved support systems for staff and providers and development of an inspirational approach to leading the entire team to provide patient-centered healthcare. July 2012, Wilmington Health partnered with Blue Cross and Blue Shield of North Carolina to form an ACO agreement. This was the first insurer-provider Accountable Care Organization in the region.
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