Reimbursement Coding Specialist

Reimbursement Coding Specialist

Hiring Department : Pediatrics

Location : Peoria, IL USA

Requisition ID : 1027775

Posting Close Date : 10/16/24

This position is located on the Peoria campus 170 miles southwest of Chicago. (On-Site Work - Not Remote).

The University of Illinois College of Medicine Peoria (UICOMP) educates 265 medical students and more than 300 physician residents and fellows annually. Additionally, it provides clinical care to more than 31,000 patients annually and conducts basic science, clinical and outcomes research.

Description:

Position Summary
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.

Duties & Responsibilities

1. 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.
2. 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.
3. Consults with physicians and ancillary personnel to resolve problems with specific charges.
4. Reviews documentation in order to verify accuracy of codes, dates of service, and assures documentation supports codes; processes provider's services as needed.
5. Verifies that demographic and insurance carriers are accurate within patient registration.
6. 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.
7. Processes all electronic & paper claims that are entered manually.
8. Reviews Epic workques (Charge Review) and corrects all errors that are delaying claim submission.
9. Reviews Epic workques & makes corrections: Claim Edit & Denials workques.
10. 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.
11. 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.
12. Performs other related duties as assigned.

Qualifications:

Minimum Qualifications

1. High school diploma or equivalent.
2. 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).
3. 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.