Prospect Medical Group
Coder
Prospect Medical Group, Anaheim, California, United States, 92808
The Medical Coder with Billing Experience is responsible for accurately assigning standardized codes to medical diagnoses, treatments, and procedures, ensuring that billing and claims processes comply with current healthcare standards and regulations. This role involves a detailed understanding of medical terminology, coding systems such as ICD-10, CPT, and HCPCS, and healthcare reimbursement methods, including insurance billing. The Medical Coder also collaborates with healthcare providers and billing teams to ensure the accuracy of claims submission and timely reimbursement. To perform this job successfully, an individual must be able to perform the job description satisfactorily. This job description reflects management's assignment of essential functions; it does not prescribe or restrict the tasks that may be assigned. The requirements listed below are representative of the knowledge, skill, and ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.Responsibilities
Coding and Documentation :
Review and analyze patient medical records to accurately assign diagnosis and procedure codes (ICD-10, CPT, HCPCS) according to coding guidelines and regulations.Ensure medical documentation is clear, complete, and supports the assigned codes.Collaborate with physicians and healthcare providers to clarify diagnosis and procedure information when necessary.
Billing and Claims Management :
Prepare, review, and submit accurate claims to insurance companies, Medicare, and Medicaid, following proper coding and billing procedures.Manage claims denials by investigating errors, providing necessary documentation, and submitting appeals as required.Monitor insurance and patient payments and follow up on unpaid claims to ensure timely reimbursement.
Compliance :
Stay up to date with changes in coding and billing regulations, payer policies, and healthcare laws.Ensure compliance with healthcare standards, such as HIPAA and other regulatory requirements, to maintain patient confidentiality and accurate billing practices.
Qualifications
Required Education/ExperienceCertification in medical coding (e.g., CPC, CCS, AHIMA or equivalent) is required.Attention to detail and accuracy in coding and billing processes.Strong analytical and problem-solving skills.Excellent communication and interpersonal skills for working with providers, billing teams, and insurance companies.Ability to manage time effectively and handle multiple tasks in a fast-paced environment.Preferred Education/ExperienceMinimum of 1+ years of experience in medical coding and billing.In-depth knowledge of ICD-10, CPT, and HCPCS coding systems.Familiarity with healthcare billing software and electronic health record (EHR) systems.Strong understanding of insurance billing claims submission, and reimbursement processes (e.g., Medicare, Medicaid, private insurance).Knowledge of HIPAA regulations and healthcare compliance standards.About Us
With approximately 9,000 physicians to serve our 260,000 members, Prospect Medical Systems is proud to be among the most innovative medical systems in California, Texas, and Rhode Island. Our extensive care services range from primary care and specialty physician services to acute care hospital and skilled nursing facilities to behavioral health and wellness services. Each of our Independent Physician Associations (IPAs) and networks support the use of advanced diagnostic and treatment tools to provide our members with convenient access to state-of-the-art healthcare. For 25+ years, Prospect Medical has been focused on our mission of supporting independent physicians where, through risk arrangements, we work closely together with health plans, facilities, and healthcare physicians for the benefit of every person who comes to us for care. We provide quality healthcare services that are designed to offer our patients highly coordinated, personalized care and that help them live healthier lives. Prospect Medical Systems manages highly successful IPAs by leveraging our best-practices, results-driven administrative services to manage patients under risk arrangements with health plans/CMS.Job Info
Job Identification: 3854Job Category: Health Information ManagementPosting Date: 10/21/2024, 07:00 PMJob Schedule: Full timeJob Shift: Day
#J-18808-Ljbffr
Coding and Documentation :
Review and analyze patient medical records to accurately assign diagnosis and procedure codes (ICD-10, CPT, HCPCS) according to coding guidelines and regulations.Ensure medical documentation is clear, complete, and supports the assigned codes.Collaborate with physicians and healthcare providers to clarify diagnosis and procedure information when necessary.
Billing and Claims Management :
Prepare, review, and submit accurate claims to insurance companies, Medicare, and Medicaid, following proper coding and billing procedures.Manage claims denials by investigating errors, providing necessary documentation, and submitting appeals as required.Monitor insurance and patient payments and follow up on unpaid claims to ensure timely reimbursement.
Compliance :
Stay up to date with changes in coding and billing regulations, payer policies, and healthcare laws.Ensure compliance with healthcare standards, such as HIPAA and other regulatory requirements, to maintain patient confidentiality and accurate billing practices.
Qualifications
Required Education/ExperienceCertification in medical coding (e.g., CPC, CCS, AHIMA or equivalent) is required.Attention to detail and accuracy in coding and billing processes.Strong analytical and problem-solving skills.Excellent communication and interpersonal skills for working with providers, billing teams, and insurance companies.Ability to manage time effectively and handle multiple tasks in a fast-paced environment.Preferred Education/ExperienceMinimum of 1+ years of experience in medical coding and billing.In-depth knowledge of ICD-10, CPT, and HCPCS coding systems.Familiarity with healthcare billing software and electronic health record (EHR) systems.Strong understanding of insurance billing claims submission, and reimbursement processes (e.g., Medicare, Medicaid, private insurance).Knowledge of HIPAA regulations and healthcare compliance standards.About Us
With approximately 9,000 physicians to serve our 260,000 members, Prospect Medical Systems is proud to be among the most innovative medical systems in California, Texas, and Rhode Island. Our extensive care services range from primary care and specialty physician services to acute care hospital and skilled nursing facilities to behavioral health and wellness services. Each of our Independent Physician Associations (IPAs) and networks support the use of advanced diagnostic and treatment tools to provide our members with convenient access to state-of-the-art healthcare. For 25+ years, Prospect Medical has been focused on our mission of supporting independent physicians where, through risk arrangements, we work closely together with health plans, facilities, and healthcare physicians for the benefit of every person who comes to us for care. We provide quality healthcare services that are designed to offer our patients highly coordinated, personalized care and that help them live healthier lives. Prospect Medical Systems manages highly successful IPAs by leveraging our best-practices, results-driven administrative services to manage patients under risk arrangements with health plans/CMS.Job Info
Job Identification: 3854Job Category: Health Information ManagementPosting Date: 10/21/2024, 07:00 PMJob Schedule: Full timeJob Shift: Day
#J-18808-Ljbffr