Documentation and Reimbursement Specialist

Nationwide Children's Hospital • Columbus, OH

30d • Hybrid

About The Position

Actively investigates claim denials, performs root cause analysis, and responds to inquiries regarding documentation, coding, and billing of professional services. Conducts claim reviews, assess charts, and collaborates to resolve issues and provide feedback. Researches and responds to coding, documentation, compliance, and reimbursement inquiries. Provides compliance and documentation education sessions to physicians and staff. Clarifies ambiguous clinical data and provide feedback for improved documentation. Resolves billing discrepancies and issues with insurance providers. Collaborates with healthcare providers to gather necessary documentation for claims. Updates billing software with relevant patient and insurance information.

Requirements

• Certified Coding Specialist Physician Based (CCS-P) Certification by the American Health Information Management Association (AHIMA).
• Certified Professional Coder (CPC) certification by the American Academy of Professional Coders.
• Proficiency with third party billing and documentation standards, particularly Evaluation and Management is essential.
• Knowledge of medical terminology and proficiency with diagnosis and CPT4 coding required.
• Excellent verbal and written communication skills.
• Ability to maintain and establish strong working relationships with physicians, support staff, and external parties.
• Able to work both as a team player and independently.
• Strong analytical abilities.
• Demonstrated aptitude for quantitative analysis and attention to detail.
• Strong problem solving, collaboration, and interpersonal skills.
• Able to balance multiple priorities and deadlines.
• Proficiency with personal computers and related software.
• Attention to patient confidentiality.
• One year of education or teaching related experience, required.

Nice To Haves

• Bachelor’s Degree, preferred.
• Five years of experience in related field (physician billing experience), preferred.

Responsibilities

• Researches and responds to coding, documentation, compliance, and reimbursement inquiries.
• Provides compliance and documentation education sessions to physicians and staff.
• Clarifies ambiguous clinical data and provide feedback for improved documentation.
• Resolves billing discrepancies and issues with insurance providers.
• Collaborates with healthcare providers to gather necessary documentation for claims.
• Updates billing software with relevant patient and insurance information.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level