Main Areas of Responsibility:
Audits medical charts and records for compliance. Provide a review of evaluation and management codes, medical diagnoses and clinical procedures ensuring that accurate medical billing conforms with legal and regulatory requirements. Trains, instructs and provides technical support to medical providers, support staff and medical coding personnel on accurate documentation supports billing and coding standards.
Additional Areas of Responsibility:
Collaborates with hospital compliance and coding staff to ensure consistent training with medical providers on professional and facility services. Reviews, develops, and/or modifies procedures, systems and protocols to achieve and maintain compatibility with UNM Medical Group billing requirements and compliance standards. Assists management with the development of the annual work plan risk assessment and evaluates external payer record requests for reconsideration, appeals and rebuttals.