About The Position
The Reimbursement/Coding Specialist assists with coordinating and maintaining USA Health System’s reimbursement program to support compliance with payment methodologies, regulatory requirements, and legislation affecting billing and collections. The role monitors payer requirements and regulatory changes, communicates updates to clinical and administrative departments, and supports appropriate coding and compliant reimbursement.
Requirements
- High school diploma or equivalent.
- Two years of medical and coding experience.
- Certification as a Certified Professional Coder within one year.
- A comparable combination of education and experience may substitute for the stated requirements.
Responsibilities
- Monitor Medicare, Medicaid, and commercial insurance carrier requirements related to documentation, coding, medical necessity, and reimbursement.
- Monitor legislative and regulatory changes affecting billing, collections, and reimbursement.
- Communicate billing, coding, and reimbursement changes to clinical departments, HIM, Pre-services, and department managers and directors.
- Assist in determining the appropriate use of CPT, ICD-10-CM, HCPCS, and other coding to maximize compliant reimbursement.
- Help identify, develop, and improve processes related to billing, collections, charge capture, and reporting.
- Identify adverse trends and operational issues and recommend corrective actions.
- Identify missed professional and technical charges and support recovery of appropriate reimbursement.
- Review third-party payer denials, research reimbursement issues, and assist with denial resolution and reimbursement recovery involving coding, documentation, payer requirements, and system configuration.
- Assist in reviewing and preparing appeals when reimbursement is denied.
- Assist with providing reimbursement trend and pattern analyses to managers and directors.
- Work claim edits and work queues within the practice management system.
- Assist in training new personnel on charge capture, reimbursement processes, and billing requirements, and provide ongoing education related to coding, billing, and reimbursement practices.
- Participate in departmental meetings to communicate policy, process, regulatory, and compliance changes.
- Maintain knowledge of current reimbursement methodologies, payer requirements, and revenue cycle best practices.
- Complete mandatory department, educational, and hospital requirements.
- Adhere to current infection control and safety standards.
- Maintain regular and prompt attendance and work the defined schedule, including overtime as required.
- Perform related duties as assigned.
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What This Job Offers
Job Type
Full-time
Education Level
High school or GED
