Ensured the accurate capture and billing of clinical services by thoroughly reviewing medical records and validating CPT, HCPCS Level II, ICD-10-CM diagnosis codes, and billing modifiers. Played a key role in safeguarding revenue integrity through comprehensive audits of clinical documentation, coding accuracy, and charge capture processes.
Responsibilities included ensuring all billable services were correctly coded and reflected in the billing system in compliance with Medicare, Medicaid, and commercial payer guidelines, as well as facility policies. Demonstrated in-depth knowledge of payer rules, NCCI edits, modifier usage, and billing regulations, while staying current with evolving coding and compliance standards through continuous training and research.
Supported pre-bill and post-bill auditing for multi-specialty and inpatient/outpatient services using Epic and 3M systems to validate documentation, charge accuracy, and submit corrections as necessary.
Key Accomplishments:
- Identified and corrected undercharges and overcharges, leading to significant revenue recovery.
- Reduced claim denials by proactively resolving coding and documentation issues before submission.
- Contributed to the creation of standard operating procedures (SOPs) and auditing workflows to enhance charge validation efficiency.
- Assisted in internal and external audits by providing detailed documentation, reports, and corrective actions.