Physician Coding Specialist II Remote

University Hospitals Pain Management; Shaker Heights (OH); Remote; USD 60,000 - 75,000; Full time

Job summary

University Hospitals Pain Management seeks a Physician Coding Specialist II to monitor and analyze unresolved third party accounts for multi-specialty group practices, initiating contact and negotiating resolutions to ensure timely payments. Responsibilities include coding edits, denials review, and potential ICD-10 coding from documentation.

Role requires knowledge of payer guidelines, effective communication with payors and internal teams, and adherence to PHI security and departmental

Qualifications

• Experience with physician coding and medical billing processes.
• Ability to review and correct coding edits and denials.
• Capable of handling PHI with confidentiality and professionalism.

Responsibilities

• Analyzes unresolved third party insurance accounts daily and follows up as needed.
• Communicates with payors and internal departments to obtain information impacting claim resolution.
• Researches customer service inquiries promptly and professionally.
• Reviews coding edits and denials; may code ICD-10 from documentation.
• May abstract CPT/HCPCS codes and perform computer-assisted coding.
• Adheres to coding rules, payer guidelines, and department productivity and quality standards.
• Maintains patient/physician confidentiality and professional interaction with patients and physicians.
• Identifies trends in insurance issues and reports findings to leadership.

Skills

Coding rules knowledge

ICD-10 coding

CPT/HCPCS coding

Phone and payer communications

PHI confidentiality

Tools

Computer-assisted coding

Job description

A Brief Overview

Under the direction of the Revenue Cycle Supervisor - Coding the Physician Coding Specialist II monitors and analyzes unresolved third party accounts for multi-specialty group practices. This position initiates contact and negotiates appropriate resolutions to ensure timely payments of outstanding claims.

What You Will Do

• Analyzes, on a daily basis and in accordance with established time frames, the outstanding insurance accounts. Initiates appropriate and effective telephone and/or written follow-up on the identified accounts.
• Communicates with payors and other internal departments as required to obtain critical information that impacts the resolution of both current and future claims.
• Researches and responds to all telephone inquiries from the customer service department, in a prompt, professional manner meeting departmental guidelines.
• Reviews and corrects coding edits and denials.
• May code ICD-10 from written documentation.
• May abstract CPT/HCPCS codes.
• May perform computer assisted coding functions.
• Working knowledge of coding rules and payer guidelines.
• Consistently meets department productivity standards
• Consistently meets department quality standards.
• Maintains patient/physician confidentiality at all times and maintains effective communication and professional interaction with patients and physicians.
• Provides appropriate information and feedback to various personnel within UHPS. Supports and utilizes established departmental guidelines. Recommends additional research to other CBO departments.
• Identifies trends with insurance related issues and reports findings to the Team Lead.
• Acts as a role model for professionalism through appropriate conduct and demeanor at all times.
• Interprets written correspondence and either resolves the problem or forwards it to another department for prompt resolution.
• Effectively communicates utilizing the telephone, form letters or internal correspondence to resolve patient inquiries.
• Handles multiple tasks simultaneously.
• Must have an understanding of insurance products and billing requirements to effectively resolve discrepancies in billing statements.
• Performs other related duties as assigned.
• This role will encounter Protected Health Information (PHI) as part of regular responsibilities. UH employees must abide by all requirements to safely and securely maintain PHI for our patients. Annual training, the UH Code of Conduct and UH policies and procedures are in place to address appropriate use of PHI in the workplace.

Additional Responsibilities

• Performs other duties as assigned.
• Complies with all policies and standards.
• For specific duties and responsibilities, refer to documentation provided by the department during orientation.
• Must abide by all requirements to safely and securely maintain Protected Health Information (PHI) for our patients. Annual training, the UH Code of Conduct and UH policies and procedures are in place to address appropriate use of PHI in the workplace.