In an outpatient clinic/physician practice context, review, analyze and code diagnostic and procedural information that determines Medicare, Medicaid and private insurance payments; provide patient representative services including telephone contacts with or on behalf of patients and physicians, internal communication regarding patient care services and administration, scheduling patient visits, utilizing electronic medical record (EMR) modules and other office equipment to perform all clerical tasks in an efficient and timely manner, filing, record preparation, collection of payments, and other duties related to office administration and coordination of service.
1. Performs patient care management in accordance with established standards and protocols, including but not limited to, scheduling, telephone contacts, , filing, record preparation, collection of payments. Provides assistance to patients on questions regarding clinical charges and basic insurance benefits
2. Works with all providers in maintenance of patient schedules for regular office visits. Accommodate adjustments to schedules based on provider’s needs
3. Effectively controls practice expenses through efficient use of medical and clerical supplies. Documents accurately and completely all CPT and/or ICD codes for treatments performed during a patient encounter.
4. Works with PPM management team to comply with all established standards required under the accreditation standards of Det Norske Veritas (DNV), as well state and federal healthcare standards and regulatory requirements. Adheres to CPH and PPM policies and procedures, protocols, and guidelines.
5. Works with PPM management team to resolve clerical issues (processes, performance, etc.) to identify opportunities for improvement.
6. Abstracts all necessary information from EMR and assigns codes (ICD-9, CPT & HCPCS), which most accurately describe each documented diagnosis, surgical procedure and special therapy or procedure according to established guidelines. Assures the final diagnoses and operative procedures as stated by the physician or other health care providers are valid and complete. Abstracts all necessary information from health records to identify secondary complications and co-morbid conditions. Queries the provider for additional information or clarification of documentation when necessary.