[Hiring] Certified Coder @Mindpath Health

Role Description

At Mindpath Health, we’re on a mission to make mental health care more accessible and more human. As a national leader in mental health services, we empower our clinicians, support our teams, and prioritize care that helps people truly thrive.

The Certified Professional Coder (CPC) is responsible for performing professional coding services for the RCM Team, while following AMA and CMS medical coding guidelines. The primary function of this position is to utilize CPT, ICD-10-CM, HCPCS and coding guidelines to ensure accurate coding as relates to medical documentation.

• Provide research and assist in resolving rejections, denials, and any coding/carrier related inquiries.
• Review, analyze, and code diagnostic and procedural information that determines Medicare, Medicaid, and private insurance payments.
• Work to remain up to date on industry coding changes, payer medical policies, and participate in continuing education courses as mandated by certification.
• Provide customer service that meets and exceeds internal and external customer expectations.
• Communicate effectively in a professional manner both verbally and in writing.
• Identify trends and solve them in a timely manner.

This position reports to the RCM Manager and will work closely with the RCM Management Team and staff. This is a fully remote, full-time role in TX, NC, SC, or FL (40 hours/week, Monday–Friday).

Qualifications

• High School Diploma or GED required.
• 3+ years of progressive experience in medical coding/reimbursement.
• Advanced knowledge of medical codes involving the selection of the most accurate and descriptive code, using ICD-10-CM, CPT and HCPCS codes for billing of third-party resources and IHS coding conventions.
• Experience using AdvancedMD, NextGen databases highly desired.
• Knowledge of insurance payer requirements as it relates to benefit coverage, referrals, and authorizations.
• Knowledge of processes and methods for maintaining clear and precise notes received from insurance payers related to insurance verification communication with payers.
• Knowledge of working with insurance companies, healthcare providers, and patients to get a claim processed and paid on a timely basis.
• Knowledge of insurance billing and collection guidelines including HMO/PPO, Medicare, Medicaid, other third-party payers, HCPCS, CPT, ICD-10, coding and medical terminology, LCDs (Local Coverage Determinations), payer billing guidelines and medical policies.
• Knowledge of assisting and resolving rejected or denied claims related to coding by contacting third party payers and/or patients for timely payment resolution.
• Knowledge working in online payer portals such as: Availity, NaviNet, Orthonet, etc.
• Knowledge of computer systems, programs, data entry, and spreadsheet applications is essential, including knowledge of MS Office applications including MS Word, PowerPoint, and Excel.
• Detail oriented self-starter with a strong work ethic.
• Highly professional, confident, conscientious and cooperative attitude.
• Strong written, verbal communication and organizational skills, as well as excellent customer service skills.
• Knowledge and understanding of legislation and regulations regarding healthcare practices and CMS regulations.
• Ability to multi-task and meet deadlines as well as be proactive, self-directing and take initiative.
• Ability to collaborate effectively with medical staff, revenue cycle team and external partners.

Requirements

• Reviews and audits charge encounters/tickets for correct CPT, ICD-10 and HCPCS for multiple facilities and systems.
• Assist with pre and post audits while maintaining compliance with the payer reimbursement policies and government regulations as well as Medicare/CMS guidelines.
• Monitor progress resulting from periodic audits and communicate with the Coding Compliance Manager.
• Account for coding and abstracting of patient encounters, including diagnostic and procedural information, significant reportable elements, and complications.
• Analyze medical records and identify documentation deficiencies.
• Serve as a resource and subject matter expert to the RCM Leadership and peers.
• Review and verify documentation to support diagnosis, procedure, and treatment results.
• Audit clinical documentation and coded data to validate documentation supports services rendered for reimbursement and reporting purposes.
• Assign codes for reimbursement, research and compliance with regulatory requirements utilizing guidelines.
• Serve as a coding resource to providers and other department staff.
• Identify discrepancies, potential quality of care and billing issues.
• Research, analyze, recommend, and facilitate plans of action to correct discrepancies and prevent future coding errors.
• Maintain confidentiality regarding patient account status and the financial affairs of the clinic/corporation.
• Thrive in a high volume medical coding and collections environment while maintaining exceptional standards of excellence.
• Perform coding or coding reviews for multiple health care encounters at the stated minimum performance level.
• Analyze code, interpret, and compile medical information/records to document patient condition and treatment.
• Code, prepare and submit clean claims to insurance companies via electronic and paper submissions.
• Assist with resolution of healthcare claims and collect the appropriate amounts as set forth by contracts or out of network reimbursements.
• Provide excellent customer service to patients, providers, and other customers.
• Maximize collections efforts to enhance the overall Accounts Receivable performance.
• Accurately review and bill all secondary and tertiary insurances to correct charges, bill forms and supporting documentation (EOBs).
• Identify coding related rejected or denied claims, work to ensure that trends are identified and resolved quickly.
• Maintain daily billing queues by working and reporting claim edits or following up on claim issues as related to coding workflow.
• Work independently while maintaining confidentiality and following HIPAA regulations.
• Manage daily workflow in a production environment and utilize all available resources to complete daily work assignments on a timely basis.
• Maintain work operations by following policies, procedures, and reporting compliance issues.
• Update job knowledge by participating in educational opportunities, reading professional publications, keeping current on Medicaid/Medicare billing, and reimbursement procedures.
• Support a teamwork environment and participate in required virtual meetings (via Teams or Zoom).
• Other assigned duties as assigned.

Benefits

• Medical, Dental, and Vision coverage.
• Employee Assistance Program (EAP).
• Life & Long-Term Disability Insurance.
• 401(k) with employer match.
• Paid time off starting at 15 days per year.
• Paid parental leave.
• Tuition reimbursement.