Reimbursement Coding Specialist

About the role

The Peds Reimbursement Coding Specialist codes physician & ancillary medical services for the purpose of receiving maximum allowable reimbursement from payors. The position performs other coding related functions such as patient registration, auditing coding transactions, research of coding issues, training and review of departmental coding procedures. They function under general supervision of the Director of Administrative Operations.

Responsibilities

• Codes complex charge documents for ancillary and physician services using standardized coding systems such as ICD-9-CM, ICD-10 and CPT, or verifies coding performed by clinical staff and lower level coders for accuracy.
• Determines actions such as submissions of additional documentation on individual claims to increase reimbursement levels and provide additional/supplementary documentation needed for payor consideration of non-routine charges.
• Consults with physicians and ancillary personnel to resolve problems with specific charges.
• Reviews documentation in order to verify accuracy of codes, dates of service, and assures documentation supports codes; processes provider’s services as needed.
• Verifies that demographic and insurance carriers are accurate within patient registration.
• Performs periodic reviews of department charge tickets and researches needed changes; recommends needed changes to appropriate supervisor; researches, reports and recommends policy changes mandated by federal and state reimbursement programs as well as those required by the payors.
• Processes all electronic & paper claims that are entered manually.
• Reviews Epic workques (Charge Review) and corrects all errors that are delaying claim submission.
• Reviews Epic workques & make corrections: Claim Edit & Denials workques. Corrects coding errors, reviews documentation, contacts the clinics/departments to determine the correct code to submit.
• Identifies discrepancies, potential quality of care, and coding/billing issues. Recommends and facilitates plan of action to correct discrepancies and prevent future coding errors.
• May train lower level employees in this series and shares coding expertise with physicians/residents.
• Serves as a resource and subject matter expert to other coding staff.
• Attends coding & reimbursement workshops to maintain level of competence & coding certification.
• Keeps abreast of changes in field.
• Performs other related duties as assigned.
• Performs duties listed in lower level of this classification series.
• Aids in the preparation of coding reports as requested.

Requirements

• High school diploma or equivalent.
• Current certification as a Certified Coding Specialist (CCS) or Certified Coding Specialist—Physician-based (CCS-P) or Registered Health Information Technician (RHIT) or Registered Health Information Administrator (RHIA) by the American Health Information Management Association (AHIMA), or current certification as a Certified Professional Coder (CPC) or a Certified Outpatient Coder (COC) by the American Academy of Professional Coders (AAPC) (formerly CPC-H certification).
• One (1) year/twelve (12) months of work experience comparable to that performed at the Reimbursement Coding Representative level of this series or in other positions of comparable responsibility.

Qualifications

To apply: For fullest consideration click on the Apply Now button, please fully complete all sections of the online application including adding your full work history with specific details of your duties & responsibilities for each position held. Fully complete the education, licensure, certification and language sections. You may upload a resume, cover letter, certifications, licensures, transcripts and diplomas within the application. Please note that once you have submitted your application you will not be able to make any changes. In order to revise your application you must withdraw and reapply. You will not be able to reapply after the posting close date. Please ensure the application is fully completed and all supporting documents have been uploaded before the posting close date.

Benefits

This position is intended to be eligible for benefits. This includes Health, Dental, Vision, Life Insurance, a Retirement Plan, Paid time Off, and Tuition waivers for employees and dependents.

Pay

$23.68 - 31.10 / Hourly Wage

Schedule

Days

Workplace Type

On-Site