Responsible for coding and/or auditing charges, diagnoses, and procedures of Ambulatory patients who undergo imaging procedures. Will perform medical necessity reviews and education aimed at reducing radiology related denials and write offs. Uses the Charge Description Master (CDM), ICD-10 CM, CPT and HCPS Coding systems. Attends clinical procedures to obtain the most accurate clinical information for charge capture and CPT coding, with real-time consultation with the physician and viewing of the clinical findings. Must code all cases within 24 hours of occurrence and perform final pre-billing reviews for accuracy following reconciliation review with dictate reports.

• Attends invasive procedures as requested by the physician or requested by the Coder. Reviews invasive procedure reports, recommends or assigns and sequences CPT and HCPCS charge master codes on radiology records, in accordance with official coding guidelines, and payer requirements to accurately code clinical procedures and charge for supplies.
• Compares and reconciles variances in the documentation of dictated reports to logs of the clinical procedures performed and supplies used.
• Performs pre-billing review of all cases and reviews (at least monthly) reports of pending and denied Imaging claims, identifying root causes for non-payment.
• Assists the Clinical Information Department by identifying coding-related revenue and reimbursement improvement opportunities for Radiology Services and reports these findings to management.
• Maintains working knowledge of the CDM for the clinical area of assignment and collaborates with the CDM Manager for Carilion Clinic and the Directors of the clinical departments to ensure that the CPT codes, procedures, supplies and revenue codes are updated as necessary, and at least annually.
• Identifies, with Purchasing, supplies that can be returned to the manufacturer for correct charging to minimize lost revenue.
• Consults with and provides education to physicians (Radiologists) regarding clinical documentation as it relates to coding requirements.
• Validates charges with Internal Audit.
• Maintains working knowledge of Sovera, SMS, 3M Encoder, RMS, Educode and Clinical Systems that support the clinical area of assignment.