ABOUT WILMINGTON HEALTH

Since 1971, Wilmington Health has been committed to the care and health of our community in Wilmington as well as all of Southeastern North Carolina. Wilmington Health is structured as a multi-specialty medical practice with primary care providers integrated into the system. In this way, Wilmington Health is able to provide a comprehensive and coordinated approach to the care of all our patients. Wilmington Health is committed to using collaborative, evidence-based medicine in providing the highest quality of care to the patients we serve.

PURPOSE:

Provide guidance and instruction regarding insurance coding protocol to ensure compliance with regulatory requirements.

ESSENTIAL DUTIES/RESPONSIBILITIES:

• Serve as a technical resource for all coding and billing regulations for provider services

• Assist in formulating policies and procedures regarding coding and billing to ensure consistency and compliance across all clinic departments

• Interact with medical staff and clinic staff to ensure quality and consistency with coding and billing policies

• Perform quality control reviews of internal audits

• Work with designated clinic administrative staff in identifying and addressing significant coding/billing issues. This may include initiating policy changes and/or identifying areas in need of corrective action plans and assist in development and execution of actions plans

• Education and training of clinic staff and medical staff

• Review and update clinic fee schedule on an annual basis

• Review and update of encounter forms/charge tickets on an annual basis

• Perform Evaluation and Management (E/M) profiling on a monthly basis

Required Skills

ADA PHYSICAL DEMANDS:

Rarely (Less than .5 hrs/day) Occasionally (0.6 – 2.5 hrs/day) Frequently (2.6 – 5.5 hrs/day) Continuously (5.6 – 8.0 hrs/day)

PHYSICAL DEMAND

REQUIRED?

FREQUENCY

Standing

Rarely

Sitting

Frequently

Walking

Occasionally

Kneeling/Crouching

Lifting

Required Experience

QUALIFICATIONS       

• High school diploma or equivalency

REQUIRED:

• 3-5 years health insurance experience, Certified Coder

PREFERRED:     

• ABSTRACT CODING EXPERIENCE

ADA PHYSICAL DEMANDS:

Rarely (Less than .5 hrs/day) Occasionally (0.6 – 2.5 hrs/day) Frequently (2.6 – 5.5 hrs/day) Continuously (5.6 – 8.0 hrs/day)

PHYSICAL DEMAND

REQUIRED?

FREQUENCY

Standing

Rarely

Sitting

Frequently

Walking

Occasionally

Kneeling/Crouching

Lifting