Reviews and ensures the accuracy of medical coding for all services rendered by assigned medical Providers including appropriate diagnostic documentation of risk and chronic conditions through a master understanding of specific CPT and ICD -10 codes.

Assigns and sequences appropriate diagnostic/procedure billing codes, in compliance with third party payer requirements.
Acts as a coding claims review specialist.
Reviews and modifies, if necessary, CPT, HCPCS and ICD-10 codes from assigned Provider visit notes in a timely fashion, ensuring all supported codes are captured on the claim form(s) and submits to the health plan; closing both HCC and HEDIS/Stars care gaps.
Queries the Provider for clarification, as needed, using communication guidelines provided by the RCD/Physician Coder.
Coding quality is at 95% accuracy or greater.
Assists in addressing unbilled/unfiled encounters.
Attend all ACO in office and Zoom meetings.
Attends medical billing and coding webinars to gain additional knowledge and share best practices with the organization.
Complete and send Daily MIS to leadership team.
Assist with other clerical tasks as needed.

Assists the Medical Billing Manager with accurate, detailed, and thorough medical billing processes. Utilize billing knowledge to ensure the timely and accurate processing of patient accounts.

Prepare, review, and transmit timely claims using billing software to various third- party payers either electronically or by paper claim processing.
Process payments as they are paid electronically and/or via paper and credit patient accounts accordingly through EHR.
Train new employees in the billing department.
Ensure billing staff employees understand and follow coding procedures, and that all medical chart codes are accurate.
Identify and bill secondary and tertiary insurances.
Review patient account balances for possible bad debt or collection monthly.
Daily check of hospital database for any new Nephrology consults. Add any new Nephrology consults into PMD. Once approved, post new claims in EMR.
Billing home health charges as necessary.
Posting monthly dialysis charges.
Assist with answering telephones and other clerical tasks as needed.

GENERAL SUMMARY OF DUTIES: Conduct thorough psychiatric evaluations, develop treatment plans, prescribe medication, and evaluate treatment results for patients with emotional, mental, or psychological disorders.

Assess, diagnose, and treat adults and youth populations over 14 years of age experiencing symptoms of behavioral health disorders.
Responsible for timely and accurate completion of medical records, including assessment, treatment plan, progress notes, outcome measures, and billing entries.
Examine or order laboratory or diagnostic tests for clients to provide information on general physical condition and mental disorders.
Refers patients for inpatient care, in collaboration with the Mental Health Division Clinical Director, as necessary.
Communicates with patients and engages in follow-up as necessary.
Oversee Mental Health treatments, such as Spravato.
Ensure compliance and that all policies and procedures function in accordance with state and federal laws and regulations.
Maintain excellent communication and effective working relationships with patients, Providers, clinical and clerical team members for continuity of high quality patient care.

Meets new and existing ambulatory patients in the clinic for examination, diagnosis, and development of patient care plans based on the patient’s medical history.
Administers and orders diagnostic tests such as x-rays, electrocardiograms, and blood work, and interprets test results.
Performs therapeutic procedures such as immunizations, injections, suturing and wound care, and managing infection.
Exercises professional judgment regarding consultation with supervising physicians concerning appropriate treatment.
Develops and implements patient care plans, instructs and counsels patients, and records progress.
Prescribes medications to the extent allowable by state guidelines and clinic regulations.
Provides general health education regarding matters such as proper diet, family planning, and health maintenance.
Assists physician with emergency treatments and more complex procedures.
Provides back up coverage for our clinic located in Maricopa, AZ.
Maintain strict confidentiality and adhere to all HIPAA guidelines and regulations.
Enforces all policies, procedures, protocols, directives and goals of the organization.