Documentation and Reimbursement Specialist

Nationwide Children's Hospital Inc; Columbus, Northern (OH, KY); Hybrid; USD 65,000 - 90,000; Full time

Job summary

Nationwide Children's Hospital Inc is seeking a Documentation and Reimbursement Specialist to investigate claim denials, perform root cause analysis, and respond to inquiries about documentation, coding, and billing of professional services in Columbus, OH. You will conduct claim reviews and collaborate to resolve issues and provide feedback.

The role demands knowledge of E/M coding, strong communication, and the ability to balance multiple priorities.

Qualifications

• Bachelor’s Degree preferred.
• Five years of physician billing experience preferred.
• Certification required: CCS-P or CPC.
• Proficiency with third party billing and documentation standards, particularly Evaluation and Management.
• Knowledge of medical terminology and CPT4 coding.
• Excellent verbal and written communication skills.

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 provides 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.

Skills

Billing knowledge

Analytical skills

Communication

Problem solving

Team player

Education

Bachelor’s degree preferred

Tools

Billing software

CPT4 coding

Medical terminology

Job description

## Documentation and Reimbursement SpecialistApply: 3700 Corporate Drive, Columbus, OH: Full time: Posted Yesterday: R-26863**Overview:**Schedule: M-F (9:00am-5:00pm)On-site until cleared to work hybrid (onsite 2 days per month after probationary period) - subject to change based on meetings**Job Description Summary:**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.**Job Description:****Essential Functions:*** 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. **Education Requirement:*** As required by listed licensure and/or certification requirement.* Bachelor’s Degree, preferred. **Licensure Requirement:**(not specified) **Certifications:*** Required to have one of the following certifications: 1. Certified Coding Specialist Physician Based (CCS-P) Certification by the American Health Information Management Association (AHIMA). 2. Certified Professional Coder (CPC) certification by the American Academy of Professional Coders. **Skills:*** 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. **Experience:*** Five years of experience in related field (physician billing experience), preferred.* One year of education or teaching related experience, required. **Physical Requirements:**OCCASIONALLY: Driving motor vehicles (work required) \\*additional testing may be required, Lifting / Carrying: 0-10 lbs, Standing, WalkingFREQUENTLY: Decision Making, Interpreting Data, Problem solvingCONTINUOUSLY: Audible speech, Computer skills, Flexing/extending of neck, Hand use: grasping, gripping, turning, Hearing acuity, Repetitive hand/arm use, Seeing – Far/near, Sitting **Additional Physical Requirements performed but not listed above:**(not specified) \"The above list of duties is intended to describe the general nature and level of work performed by individuals assigned to this classification. It is not to be construed as an exhaustive list of duties performed by the individuals so classified, nor is it intended to limit or modify the right of any supervisor to assign, direct, and control the work of employees under their supervision. EOE M/F/Disability/Vet\"