Locola Jones

Verify and ensure the accuracy, completeness, specificity and appropriateness of diagnosis codes based on services rendered. Review medical record information to identify all appropriate coding based on MHS guidelines, CMS, and AMA.

Responsible for assignment of accurate patient encounters into codes using E&M, ICD, CPT codes. Responsible for overseeing a staff of medical coders. Performed peer to peer reviews and audits for outpatient encounters. Provide education to providers and coders as needed to ensure correct coding and to ensure documentation is clear and supports coding assignments. Code multiple clinics/specialties (Emergency Department (&I), Family Practice, Pediatrics, Gastroenterology, OB/GYN, PT/OT, Nutrition and Mental Health Behavior.) Maintains a Open encounter report of missing records in order to facilitate completion of work within the required thresholds. Use a variety of computer applications in day to day duties, such as Outlook, Micro Soft, DHA systems ( DCAT, CHS, Essentris, AHLTA and CCE.) Assigns, validates, and/or edits procedure categories, modifiers (when applicable). Initiates physician queries in compliance with DHA MHS policy where appropriate. Apply resources to assure coding knowledge and skills remain current. Utilizes the complete medical record documentation in code assignment.

Reviews, analyzes, and codes medical record documentation to include procedural information for the correct ICD-10, CPT and/or HCPCS codes to the greatest specificity. Reviews documentation for medical necessity. Primary coding responsibility is all Evaluation and Management (E/M) leveling along with coding GYN surgical procedures.. Sequence appropriate diagnostic/procedure billing codes in compliance with Medicare and other insurances. Ensure proper coding on provider documentation. Inform physician of incomplete/missing documentation. Ensure all codes are current year and active, ensure edit request are handled
within 72-hour window through the system/process.

Assign codes for diagnosis and procedure using ICD 10 CPT , E&M tool and HCPCS codes..Assigns E/M levels and procedures and for office and radilology encounters.Search for information in cases where the coding is complex or unusual. Ensure all codes are current and active. Perform accurate charge entries. Liaison with physician and other clinical staff to clarify handling clinical reports about patient treatment, diagnosis, and related procedures to ensure proper coding. Daily edit review and completion of edit accounts Reviewed all official data quality standards, coding guidelines, Ensure codes are accurate and sequenced correctly in accordance with CMS and commercial insurance regulation. policies and procedures, and clinical/medical resources to assure coding knowledge. Assigns E/M levels and procedures and enter for office and radilology encounters.

Identifies and codes diagnoses and procedure codes for information documented in the medical records and operative report according to ICD-10-CM, and CPT-4 guidelines, including hospital and office visit encounters. Responsible for billing charges and posting payments to patient accounts. Monitor and resolve financial discrepancies. Arrange payment plans and timelines for payments. Daily work A/R report for patient and insurance balances. Review referrals and authorizations. Insurance verification and patient inquiries.