Documentation and Reimbursement Specialist

Nationwide Children's Hospital; North Carolina; On-site; USD 65,000 - 90,000; Full time

Job summary

Nationwide Children's Hospital in the United States is seeking a Medical Billing and Coding Specialist to investigate claim denials, perform root cause analysis, and respond to inquiries about documentation, coding, and professional services.

You will review charts, resolve billing discrepancies with insurers, and collaborate with physicians to gather necessary documentation, while maintaining patient confidentiality and compliance.

Qualifications

• Five years physician billing experience preferred.
• One year education or teaching related experience required.
• CCS-P or CPC certification required.

Responsibilities

• Research and respond to coding, documentation, compliance, and reimbursement inquiries.
• Provides 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.

Skills

Medical coding

Billing accuracy

Communication skills

Team collaboration

Analytical ability

Problem solving

Confidentiality

Education

Bachelor's Degree

Tools

Billing software

EMR systems

Job description

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, Walking

FREQUENTLY: Decision Making, Interpreting Data, Problem solving

CONTINUOUSLY: 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”