Reimbursement Specialist - Corporate Reimbursement/Coding - Full Time

Guthrie Enterprise•Sayre, PA

About The Position

Description Position Summary: Provide a high level of technical competency and serves as a subject matter expert regarding documentation guidelines, coding, and reimbursement. Responsible for education of providers, residents, and staff to ensure compliance with billing guidelines and proper documentation. Strong ability to promote revenue integrity processes within the organization. Education, License & Cert: High School Diploma or equivalency required. Degree in Health Information Technology or possession of RHIA, RHIT, CCS, or CPC certification required. Minimum three years’ experience in physician coding and reimbursement. Experience: Must have comprehensive knowledge of Medicare, Medicaid, and other third‐party payer coding and billing regulations. Must be able to demonstrate a strong knowledge of CPT, ICD‐10‐CM and HCPCS coding systems and guidelines, medical terminology, anatomy, and physiology. Demonstrate strong verbal and communication skills. Teaching and/or training experience required. Strong analytical abilities and problem‐solving skills required. Proficient computer skills: Epic, Word, Excel, and System Reports. Essential Functions: 1. Develop and provides education to physicians, residents, office staff, and others throughout the organization that may require coding knowledge. 2. Perform clinical and coding reimbursement assessments to ensure revenue capture. Make recommendations to appropriate providers, staff, and leadership partners. 3. Communicate with all parties involved the results of quality coding/documentation reviews. 4. Research coding and billing guidelines and assisting Managers/Providers/Staff with coding related rejections and WQ edits. Recommend process improvements or educate staff to prevent future rejections. 5. Works collaboratively with centralized inpatient coder and central charge entry to ensure all charges are captured. 6. Perform special audits upon request to analyze billing activity. 7. Ensure all regulations are met and claims subsequently submitted to payers accurately. Other Duties: 1. Contribute to maintaining a team environment. Must work in a way that demonstrates and promotes teamwork. 2. Maintains confidentiality regarding patient accounting. 3. Performs other duties as assigned.

Requirements

High School Diploma or equivalency required.
Degree in Health Information Technology or possession of RHIA, RHIT, CCS, or CPC certification required.
Minimum three years’ experience in physician coding and reimbursement.
Must have comprehensive knowledge of Medicare, Medicaid, and other third‐party payer coding and billing regulations.
Must be able to demonstrate a strong knowledge of CPT, ICD‐10‐CM and HCPCS coding systems and guidelines, medical terminology, anatomy, and physiology.
Demonstrate strong verbal and communication skills.
Teaching and/or training experience required.
Strong analytical abilities and problem‐solving skills required.
Proficient computer skills: Epic, Word, Excel, and System Reports.

Responsibilities

Develop and provides education to physicians, residents, office staff, and others throughout the organization that may require coding knowledge.
Perform clinical and coding reimbursement assessments to ensure revenue capture. Make recommendations to appropriate providers, staff, and leadership partners.
Communicate with all parties involved the results of quality coding/documentation reviews.
Research coding and billing guidelines and assisting Managers/Providers/Staff with coding related rejections and WQ edits.
Recommend process improvements or educate staff to prevent future rejections.
Works collaboratively with centralized inpatient coder and central charge entry to ensure all charges are captured.
Perform special audits upon request to analyze billing activity.
Ensure all regulations are met and claims subsequently submitted to payers accurately.
Contribute to maintaining a team environment.
Must work in a way that demonstrates and promotes teamwork.
Maintains confidentiality regarding patient accounting.
Performs other duties as assigned.