AAPC of Kansas City Welcomes You!
AAPC of Kansas City Welcomes You!

News

Take time to check out the AAPC Blog

Using Data Analytics to Identify Risk / Opportunity and Focus Your Auditing and Monitoring
AAPC KC May 14, 2020 Local Chapter Meeting Handout
DRAFT - Zeroing in on....AAPC KC_2020.0[...]
Adobe Acrobat document [904.4 KB]
Highlights of the CMS Evaluation and Management Office/Outpatient Visit Changes for 2019 & 2021
Huge shout out to our own Richelle Marting, JD, MHSA, RHIA, CPC, CEMC, CPMA, CPC-I and Linda Vargas, CPC, CPCO, CPMA, CPC-I, CCC, CEMC, CGSC for this summation of the upcoming changes to the Office/Outpatient E/M services that is part of the “Patients over Paperwork” initiative.
Highlights of the CMS EM Final Rule.pdf
Adobe Acrobat document [245.1 KB]
Tips to Avoid Improper Payment(s) Due to Insufficient Documentation
During a POE AG meeting, it was suggested that WPS Government Health Administrators collaborate with members in an effort to author an article that addresses insufficient documentation errors. Recognizing the need to reduce improper payment associated with those errors, members would then share the article with their Medicare business associates and partners organizations. Please review and share with your colleagues and peers.
Tips to Avoid Insufficient Documentation[...]
Adobe Acrobat document [269.2 KB]

Career Links

Below are links to job and career pages for various healthcare orgainzations in our area. 

 

Advent Health

 

Blue Cross Blue Shield Kansas City

 

Cerner

 

 
 
 
 
 
 
 

University of Kansas Health System

 

Job Postings

Mid-America Rheumatology Consultants, PA

Biller/Coder

 

Position Summary:

The primary responsibility in this position is to handle patient billings and accounts. This is a full-time position.

Reporting Relationship:  Reports to Office Manager

Responsibilities/Essential functions:

  • Enter ICD-10, CPT codes and charges for claims
  • Follow up with Providers or nursing staff on any documentation that is unclear
  • Gather allowables from insurance companies each quarter
  • Review monthly insurance newsletters for coding changes
  • Answer patient questions regarding general insurance questions
  • Post insurance payments & patient payments into our system
  • Review unpaid insurance claims.  Do appeals on claim denials
  • Call patients on overdue accounts
  • Back-up for infusion pre-certifications
  • Maintain patient confidentiality
  • Adhere to Company policy and guidelines, as well as applicable Federal, state and local laws and regulations.
  • All other duties as assigned. 

Minimum Qualifications 

  • College degree
  • Effective verbal, reading, and listening communication skills
  • Perform basic business math skills
  • Strong attention to detail
  • Ability to work effectively in a team environment

 

Preferred Qualifications 

  • Work in private medical practice billing office
  • Prior experience in medical billing 

 

Physical Requirements:

  • Ability to lift up to 5 pounds frequently and 10 pounds occasionally, along with in-frequent pushing, pulling or moving paperwork.
  • Ability to communicate with patients, providers and insurance companies
  • Prolonged periods of sitting 

 

If interested, email resume to angiechladek@marckc.com 

Clinical Investigator

 

Job Description Summary :

As part of Blue KC’s Special Investigation Unit (SIU), the Clinical Investigator will review and investigate cases of potential fraud, waste and abuse (FWA). Conduct clinical reviews of medical documentation for appropriate coding and medical necessity. Research, review and analyze data to make clinical determinations. Make recommendations and Report findings and represent the SIU to both internal and external stakeholders. Document findings and recommendations in accordance with SIU policies and procedures.

 

Job Description

1. Conducts pre-payment and post-payment clinical reviews of medical documentation to ensure appropriate coding, provide medical review interpretation and medical necessity. Drafts medical records review summaries for each completed investigation.  Support non-clinical SIU Fraud Investigators on cases through medical records review and clinical consulting.
2. Act as a clinical liaison between Medical Management, Medical Directors, Facets configuration teams, audit recovery vendor, and FWA vendor. Attend Medical Policy Review meetings to represent the SIU and recommend policy changes or edits and recommend new policies. Work with vendor based claim audit recovery program to research and develop new audit concepts to identify overpayment for recovery. Works with Clinical Reimbursement team to research, address and to implement new claims edits and/or edit existing edits. 
3. Perform ongoing FWA risk assessments, leveraging data analytics to identify trends, patterns, outliers relative to peers and clinical standards, etc.  In conjunction with the Manager and/or Senior Investigator, evaluate FWA risks and prioritize for further review, based upon member health/safety and protection of plan assets.
4. Monitor hotlines, internal referrals, external fraud alerts (e.g., CMS, BCBSA), external healthcare anti-fraud workgroups, and other resources potential FWA schemes.
5. Perform triage analysis on incoming leads and referrals to the SIU
6. Conduct investigations of FWA in accordance with SIU policies and procedures.  May work with Manager and/or Senior Investigator on larger, more complex, investigations.  Create and maintain detailed case files in accordance with SIU policies and procedures, where key investigative activities and outcomes are timely and accurately documented. Prepare detailed case reports summarizing investigative findings and recommendations.  Present reports to key stakeholders (e.g., Provider Relations, Medical Management, Pharmacy, Claims, Legal). 
7. Coordinate responses to subpoenas and preparation of cases for referral to law enforcement and/or regulators.
8. Perform day-to-day activities for vendor-based claim overpayment recovery program (e.g., data file exchanges, proposing / reviewing new audit concepts, coordinating claim adjustments, invoices).
9. Prepare reports for FWA Work Group meetings, executive updates, Blue KC Audit Committee, BCBSA/FEP surveys, and other reports as needed.
10. Assist manager in coordinating FWA training program for Blue KC employees and First Tier, Downstream and Related entities.

Minimum Qualifications

  • Bachelor’s degree in nursing 
  • Active professional RN license in Missouri and/or Kansas
  • 5 years’ experience conducting medical and/or coding review audits
  • Strong communication skills with a broad range of individuals and groups (e.g., members, providers, operational areas, medical directors, provider relations, legal counsel, senior management)
  • Strong written and verbal skills
  • Intermediate knowledge of medical policies, terminology and ICD/CPT coding
  • Intermediate knowledge of claims processing, clinical edits and reimbursement applications
  • Intermediate knowledge of Clinical Guidelines.
  • CPC Coding Certification: AAPC, CRC, CDEO, CMRA, or AHIMA must be obtained within 12 months of hire date.

 

Preferred Qualifications

  • Master’s degree in nursing
  • 5 years’ experience at a health plan (e.g., medical review, provider relations, medical analytics, research & adjustment, appeals) that provided the types and levels of knowledge, skills, and abilities required.
  • 5 years’ experience providing direct patient care.
  • Experience analyzing claims data to identify FWA trends and patterns using tools such as Excel and business intelligence platforms (e.g., Power BI, Business Objects).
  • Intermediate knowledge of major BCBSKC business systems (e.g., Facets, ITS Host and Home) and operational processes (e.g., Claims Processing, Pharmacy, Provider Contracting/Relations, Member Services, Customer Service).
  • Intermediate knowledge of BCBSKC provider contracts, medical policies and member benefits.
  • Experience working with the regulators (e.g., CMS, State Department of Insurance) and law enforcement (e.g., FBI, DEA, HHS-OIG, OPM-OIG and/or Department of Justice)
  • FWA Certifications: Accredited Healthcare Fraud Investigator (AHFI) (Highly Preferred), Certified Fraud Examiner (CFE)

 

Apply at:  https://bcbskc.wd1.myworkdayjobs.com/en-US/BCBS_External_Career_Site/job/Corporate-Office-Kansas-City-MO/Clinical-Investigator_R2911-1

 

Prime Healthcare Coder II

 

This is a full time remote coding position.

 

JOB SUMMARY:  The Coder Physician Group analyzes abstracts and codes the diagnostic and procedural information for physician outpatient and office medical records utilizing the International Classifications of Diseases, Tenth Revision (ICD-10-CM) and Current Procedural Terminology (CPT) in accordance with regulatory agencies and physician office specific guidelines. The Coder Physician Group enters the coded data and other abstracted data from the medical record into the electronic information system, facilitating the physician offices and the billing department’s indexing responsibility for internal use (such as to support medical care evaluation studies), and mandated reporting requirements. Holding a senior coding position, primary role in assisting medical staff members with improving quality of documentation.  Participates in chart review projects as assigned.

 


EDUCATION, EXPERIENCE, TRAINING

 

1.  Minimum one year experience with ICD-10 and CPT coding in an acute care setting; required.

2. Basic computer experience; required. Excel preferred.

3. Computer data entry with 10-key preferred, with accurate typing speed of 35 wpm; preferred.

4 Successful completion of college level courses in anatomy, physiology, medical terminology, and coding

5.  ICD and CPT; CPC certification, required

6. ortho/ general surgery preferred

 

Please send resumes to Lori Call at lcall@primehealthcare.com or apply online at St. Joseph Medical Center.

 

 

Insurance Follow-up/Back Coding 

 

Qualifications

  • Experience:
    • CPC, 1 year (Preferred)
    • Follow Up, 2 years (Preferred)
  • License:
    • CPC (Preferred)

Job Description

The Insurance Follow up/back coding position will be required to do the following.

  • Coding knowledge/ billing with Modifiers and reading operative reports and office notes
  • Knows Medicare and Commercial insurance policy for follow up on surgery and office charges
  • Good communication and people skills
  • Proper phone etiquette, will be the primary person answering patient phone calls and billing questions
  • Be able to analyze report data to problem solve.
  • Be able to keep sensitive information confidential.
  • Learn functions of Allscripts PM and EHR to be able to problem solve
  • Prepare delinquent accounts for collections
  • Prepare refunds for insurance overpayments
  • Back up to billing office lead for coding
  • Perform all functions of insurance follow up to include utilizing all websites
  • Knowledge of EOB’s and appeal processes
  • Certified CPC or willingness to renew certification
  • Ability to read and decipher patient ledger in Allscripts
  • Basic knowledge of deductible, copay and co insurance and the difference between each of these.
  • Be willing to pick up other tasks as needed
  • Be willing to work as a team member

Job Type: Full-time

Schedule:

  • Monday to Friday

Experience:

  • CPC: 1 year (Preferred)
  • Follow Up: 2 years (Preferred)

 

 

Elvin Govada, MHA
Administrator | Head & Neck Surgery of Kansas City
Ph: 913-599-4800 | egovada@hnskc.com

5370 College Blvd, Ste 100

Overland Park, KS 66211

 

 

 

Outstanding Opportunity

 

Johnson County Specialty Practice has an opportunity for your career advancement.  This private practice is searching for a great practice-based experienced CPC with leadership traits.   If you have a business office background (Revenue Cycle experience) along with your coding certification, AND you have the talent and drive to progress into a leadership role, this could be a great career move. 

 

Please send your resume to me, Syd Stevens, as I will be vetting for this position and will be able to provide more particulars for you.  Nice start up salary.  CPC-A’s with the experience mentioned very welcome to apply.

 

Interested candidates:  sstevens@mncpc.com

 

 

Outstanding Opportunity

 

Midwest Nephrology Consultants, P.A. has an temporary opening for an independent contractor (PRN) coder with significant experience with inpatient ICD-10 coding.  Will be able to work from home and will need to be able to access hospital records with authorization.  Compensation will be commensurate with level of experience and will be per chart.  Production quotas NOT required.  We need quality review and coding selections.  Work as much as you want whenever it’s best for you.

 

Please send experience and resume to sstevens@mncpc.com.  Will entertain resumes from CPC-A’s if you have the experience. 

  

 

 

Member Spotlight

Make sure to check out the Member Spotlight on the Membership Tab.

Want to Become a Member?

Please click on the Membership tab at the top of this page for details.

 

AAPC of Kansas City

PO Box 12431
Kansas City, MO 64116

Scholarships

AAPC of KC offers scholarships to our members for local chapter events.  See the scholarship application.

 

2019 AAPC KC Scholarship Form
Scholarship Application Form - Updated 0[...]
Adobe Acrobat document [360.8 KB]

Mentor Program

Do you need a Mentor, or would you like to become a Mentor? The AAPC of KC has a program to pair up members that need a little guidance and support with members who have a wealth of knowledge to share.

This program was developed to help our new and newly credentialed members with the support that is needed in our chosen career field.,Syd Stevens (sstevens@mncpc.com), Member Development Officer, can answer any questions you may have about this program.

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