As Avalon continues to grow and serve more veterans and first responders, we need assistance to provide the TBI Centers with expertise to maximize reimbursement. A certified coding expert is crucial for ensuring timely and accurate claims submission and reimbursement for the comprehensive services our TBI centers provide our clients. With patient volume increasing significantly along with our three-day evaluations and three-week intensive outpatient programs, it is critical to our sustainability that we capture all appropriate CPT, ICD-10, and Modifier codes as part of our standard billing practices.
 

1. Work with the Avalon TBI Centers to increase knowledge and assist to maximize the coding and billing process to include filing with the appropriate codes and language. This position will also interact with our contracted insurance providers. An essential aspect of this role will be a comprehensive review of all current coding and billing practices throughout the Alliance to identify potential gaps in underutilized and unidentified codes for neurological, physical therapy, occupational therapy, speech therapy, mental health, care management and any additional services provided to our clients.

2. Monitoring and managing all coding recommendations. Working closely with all Alliance TBI Centers, including Billing Managers and external billing companies, the Certified Coding Expert will implement all recommended additions and changes to our billing and coding practice to ensure each facility is able to maximize reimbursement and achieve sustainability. This will include all new codes as published by the American Medical Association each year.

3. Along with the VP of Billing and Reimbursement, the Certified Coding Expert will conduct a quarterly audit of all Avalon TBI centers billing and reimbursement procedures to ensure that submitted codes for services provided are reimbursed at the rates and terms negotiated through national and regional agreements, including both government and commercial payer organizations.

4. Tracking and Reporting. Working closely with each of the Avalon TBI Centers, external billing companies and the VP of Billing and Reimbursement, the Certified Coding expert will assist in the development of a tracking and monitoring system that will allow for accurate reporting of captured payment data that is linked directly to a revised coding platform.

5. The Certified Coding Expert will assist the VP of Billing and Reimbursement in quarterly reviews of all claims denials and appeals to ensure that all appropriate codes are utilized to successfully reverse negative payment decisions by payer organizations. The Certified Coding Expert may be asked to assist in the development of standardized appeals letters to address specific coding concerns and issues.

6. Be involved with monthly billing and coding calls and share best practices across the Avalon TBI Centers.