Claims Coding Specialist (Medical Coder)

Job Description

Join a world-class academic healthcare system, UChicago Medicine, as a Claims Coding Specialist (CCS) in our Revenue Cycle - Revenue Integrity Department, serving multiple areas such as Breast, Gastro and General Surgery. This position will be primarily a work from home opportunity with the requirement to come onsite as needed to our Hyde Park location . You may be based outside of the greater Chicagoland area.

The Claims Coding Specialist (CCS) works under the supervision of the Revenue Integrity. The CCS team works collaboratively with physicians, assigned to his/her team/group in order to provide an optimal revenue cycle environment that is efficient, effective, comprehensive and compliant. The CCS team also works collaboratively with the ambulatory practice managers, billing staff and (at times) insurance payers to support a highly efficient, effective, and compliant revenue cycle program. The typical work includes the resolution to coding edits for all payers, revenue reconciliation, identifying and/or organizing appropriate education for physicians, and effective communication. The Claims Coding Specialist will also be responsible for the completion of all work assignments in a proficient and accurate manner; meeting productivity and quality standards set by the Revenue Integrity Director. The Claims Coding Specialist reports directly to the Revenue Integrity Manager.

Essential Job Functions

• Works directly with the hospital departments and ambulatory clinics to resolve coding and charging issues for all payers (NCCI, OCE, MUE, LCD, payer custom edits), including but not limited to denials and disputes.
• Review medical documentation for assigning billing modifiers to insurance claims where appropriate and applicable.
• Works assigned work queues daily with the goal to complete all assigned tasks.
• Serves as a primary resource supporting in-clinic physicians/providers. As such, organizes appropriate education for physicians and communicates regularly with physicians/providers to improve the overall claims, revenue cycle, and business functions of the practice. Routinely communicates with medical staff, practice administrators, billing staff and payers as needed to discuss clinical questions with respect to coding assignment or resolution in a courteous and professional manner.
• Meets regularly with the practice manager and medical director to review in-clinic revenue cycle performance and to identify appropriate solutions for advancing an efficient, effective, and compliant revenue cycle program.
• Perform charge reconciliation and work with the physicians/providers and/or practice managers in instances of missing revenue.
• Assist with identifying trends and opportunities to address root causes, updates systems and/or provider feedback/education/training.
• Maintains current knowledge of all billing and compliance policies, procedures and regulations and attends appropriate training sessions as required.
• Assist with orientation of newly hired Claims Coding Specialists.
• Attends and participates in team meetings to discuss coding/charging issues and serves on task forces as needed.
• Meets all productivity and quality expectations and participates in all scheduled audits.
• Performs other duties as requested by management.

Required Qualifications

• Coding certification required within 3 months of hire: Health Information Management or Coding certification required within three months of hire: RHIA (Registered Health Information Administrator), RHIT (Registered Health Information Technician), CPC (Certified Professional Coder), COC (Certified Outpatient Coder), CCS (Certified Coding Specialist), CCS-P (Certified Coding Specialist Physician), or CCA (Certified Coding Associate).
• High school diploma.
• Ability to identify trends and recommend solutions to billing and revenue cycle processes and problems.
• Proven working knowledge of CPT (Current Procedural Terminology) and ICD (International Classification of Diseases) coding systems.
• Knowledge of Federal billing regulations governing Medicare and Medicaid programs, and working knowledge of other managed care and indemnity (third party) payor requirements.
• Must possess a working knowledge of Local and National Coverage Determination policies (LCD’s and NCD’s), Ambulatory Payment Classification (APC) related edits such as the National Correct Coding Initiative (NCCI) and Outpatient Code Editor (OCE).
• Must be proficient in Microsoft Excel and Word.
• Must be highly analytical, and have excellent written and verbal communication skills.
• Must possess excellent organizational, time management and multi-tasking skills, along with demonstration of excellent interpersonal skills.

Preferred Qualifications

• Two (2) or more years' experience coding.
• Epic, IDX and Centricity experience.
• Associate or Bachelor’s degree in a health-care information or health care finance related field.

Position Details:

• Job Type/FTE: Full Time (1.0 FTE).
• Shift: Days.
• Work Location: Flexible Remote/ Hyde Park Main Campus.
• Unit/Department: Revenue Cycle - Revenue Integrity.
• CBA Code: Non-Union.

Why Join Us

We’ve been at the forefront of medicine since 1899. We provide superior healthcare with compassion, always mindful that each patient is a person, an individual. To accomplish this, we need employees with passion, talent and commitment… with patients and with each other. We’re in this together: working to advance medical innovation, serve the health needs of the community, and move our collective knowledge forward. If you’d like to add enriching human life to your profile, UChicago Medicine is for you. Here at the forefront, we’re doing work that really matters. Join us. Bring your passion.

UChicago Medicine is growing; discover how you can be a part of this pursuit of excellence at: UChicago Medicine Career Opportunities.

UChicago Medicine is an equal opportunity employer. We evaluate qualified applicants without regard to race, color, ethnicity, ancestry, sex, sexual orientation, gender identity, marital status, civil union status, parental status, religion, national origin, age, disability, veteran status and other legally protected characteristics.

Must comply with UChicago Medicine’s COVID-19 Vaccination requirement as a condition of employment. If you have already received the vaccination, you must provide proof as part of the pre-employment process. This is in addition to your compliance with the Flu Vaccination requirement as well. Medical and religious exemptions will be considered consistent with applicable law. Lastly, a pre-employment physical, drug screening, and background check are also required for all employees prior to hire.