Coding and Reimbursement Specialist II: Kelsey-Seybold Clinic Pearland, TX

UnitedHealth Group•Pearland, TX

2d•$20 - $36•Remote

About The Position

The Coding and Reimbursement Specialist II ensures accurate coding and reimbursement of claims submitted to third-party payors. The role analyzes patient accounts and chart notes to validate CPT, ICD-10, and HCPCS codes; abstracts chart information; and updates provider procedural and diagnosis coding as needed. Working with the Accounts Receivable team, the specialist analyzes denials, interprets medical policies, supports appeals, researches denial trends, and recommends process improvements to help prevent future claim rejections. The position also provides coding support to multiple Business Office departments and communicates with physicians, administrative staff, and department management. Remote work is available for candidates based in the Houston/Pearland, Texas geographic area.

Requirements

Associate degree in Business Administration or a related field may substitute for two years of experience.
Certified Professional Coder (CPC), Certified Coding Specialist–Physician Based (CCS-P), or Certified Coding Associate (CCA) certification.
At least 3 years of ICD-10, CPT, and HCPCS coding/abstracting and healthcare billing and collections experience.
Diversified understanding of commercial insurance and CMS rules and regulations.
Working knowledge of commercial insurance and CMS.
Knowledge of commercial payer policies, NCCI edits, and EOBs.
Understanding of EOBs and strong PC skills.
Familiarity with commercial payer websites and tools.
Presentation skills and excellent written and verbal communication skills.
Ability to analyze, audit, and reconcile accounts.
Ability to communicate clearly with physicians and administrative staff.

Nice To Haves

At least 5 years of healthcare billing and collection experience.
Knowledge of secondary or supplemental insurance claim filing (COB).
Experience with EPIC.
Ability to retain composure, meet deadlines, and analyze, research, and resolve problems in a stressful environment with constant work-related interruptions.
Dependability and ability to work independently.
Multi-specialty coding experience.

Responsibilities

Work assigned coding-related system and web-based work files.
Analyze accounts promptly upon accessing assigned files to prevent missed filing or appeal deadlines, and appeal appropriately.
Perform duties in accordance with federal and state billing rules, contractual obligations, and department policies and procedures.
Adjudicate claims in accordance with established coding guidelines and departmental policies and procedures.
Correct physician coding as needed and refile corrected claims.
Research denied claims using payer websites and reimbursement guidelines to obtain necessary information.
Meet established production and quality standards.
Identify payer reimbursement patterns and trends, and alert management with recommendations as needed.
Conduct in-depth physician specialty rejection audits and recommend charge rules, claim edits, and Best Practice Alerts (BPA).
Serve as a coding resource for CBO employees regarding coding-related denials, appeals, and timely account responses.
Analyze and resolve aged accounts and provide feedback to the supervisor to support auditing and training of junior follow-up representatives.
Maintain licensing by completing required annual CEUs, stay current on payer reimbursement guidelines and policies, and share relevant information with department management.
Keep abreast of CPT and ICD-9/10 coding changes.
Attend seminars and conferences to maintain AAPC coder certification.
Perform other duties as assigned.