Senior Coder, Ambulatory Surgery Center

Company: CARTI
Location: Little Rock
Posted on: August 7, 2022

Job Description:

JOB SUMMARY: The ASC Coding and Authorization Specialist will work collaboratively with the ASC leadership team and Finance team to ensure proper processes are in place for the efficient and accurate handling of prior authorizations as well as charge capture and coding. This position will be responsible for verifying the patient's payer coverage/non-coverage to obtain the proper prior authorization necessary for full reimbursement for services from the payer. The ASC Coding and Authorization specialist will also be expected to be the expert in ASC coding procedures and guidelines in compliance with federal, state and payer requirements and regulations.
EDUCATION, CERTIFICATION, LICENSURE, REGISTRATION: College degree or equivalent. EXPERIENCE, KNOWLEDGE, SKILLS and ABILITIES: 1. Minimum of six years' experience working in Oncology prior authorization and/or coding field. 2. Minimum of two years' experience working in an ASC environment.3. Coding Certification from an accredited program for ASC coding (CIRCC, CCS, CPC) is required.4. Knowledge of CPT/ICD 10-cm and HCPCS for devices and supplies.
SPECIFIC JOB DUTIES AND RESPONSIBILITES:1. Pre-Authorization Verification a. Participates in facility specific training as requiredb. Follows the established protocol for pre-authorization services and provides insight for policy and procedure revisions to stay in line with best practice standardsc. Verifies all insurance coverage and determines patient's responsibility if applicabled. Obtains precertification number if applicablee. Determines patient qualification for coverage by payer and informs financial counselor, patient, or family member of statusf. Maintains current list of facility insurance contracts and payment schedulesg. Documents prequalification for payer before date of scheduled admissionh. Maintains current information on correct and lawful practices for billing government and private payers for ambulatory surgery carei. Follows all federal, state, and regulatory guidelines to maintain compliancej. Enters all insurance information into computerk. Ensures that patient financial counselor is aware of any copayments, deductibles, etc.2. Medical Codinga. Participates in facility specific training as requiredb. Follows the established protocol for coding services and provides insight for policy and procedure revisions to stay in line with best practice standardsc. Reads and understands operative reportsd. Assigns CPT and HCPCS procedure code for each case in a timely mannere. Questions physicians' offices or business office coordinator regarding any complex/unusual casesf. Understands concept of unbundling and heeds government and payer regulationsg. Assigns diagnosis codes to the highest level of specificityh. Understands Medicare/payer groups rules and regulationsi. Understands and abides by billing compliance regulationsj. Understands anatomyk. Appends bilateral, multiple procedure, and special requirement modifiers appropriatelyl. Completes coding form

Keywords: CARTI, Little Rock , Senior Coder, Ambulatory Surgery Center, Healthcare , Little Rock, Arkansas