Reimbursement Coding Representative (U) (4839)

SIU Medicine; Springfield (IL); On-site; USD 60,000 - 90,000; Full time

Job summary

SIU Medicine seeks a skilled medical coder to assign ICD-10-CM diagnosis codes and CPT/HCPCS procedure codes for inpatient and outpatient services after reviewing medical records documentation. The role requires knowledge of ICD-10-CM, CPT, and HCPCS coding systems and adherence to payer regulations.

Responsibilities include ensuring accuracy of modifiers for E/M, assisting with claim corrections and appeal letters, and advising administrators and staff on coding standards.

Qualifications

• Knowledge of ICD-10-CM, CPT and HCPCS coding systems.
• High school graduation or equivalent.
• 6–18 months healthcare coding experience with ICD-10 and CPT in clinical settings.
• Current professional coding certification satisfying AHIMA or AAPC requirements.

Responsibilities

• Assign ICD-10-CM diagnosis and CPT/HCPCS procedure codes for inpatient and outpatient services.
• Review records for accuracy of modifiers for E/M and procedure codes.
• Assist with corrections of claim information and prepare appeals when needed.
• Provide guidance on coding/documentation and payer regulations to staff and administrators.
• Support other coders and participate in training as requested.

Skills

Medical terminology

ICD-10-CM coding

CPT coding

HCPCS coding

Analytical ability

Mathematical ability

Organizational ability

Interpersonal communication

Education

AHIMA/AAPC CPC/CCA/CCS/CCS-P certs

Certified Professional Coder-Apprentice CPC-A

RD/ RHIT or RHIA (AHIMA)

High school diploma

Job description

The primary purpose of this position is to assign ICD-10-CM, CPT, and HCPCS codes for inpatient and outpatient services by reviewing medical records documentation for those services provided by a physician or other qualified healthcare professionals.

Examples of Duties

• Review documentation and assign diagnosis and procedure codes for ancillary and other physician services using standardized coding systems such as ICD-10-CM, CPT, and HCPCS.
• Review records for accuracy in the usage and/or assignment of modifiers for Evaluation and Management services along with any procedure modifiers as applicable.
• Respond to requests from Patient Business Services for assistance in correction of claim information in regard to coding, dates of service, place of service, provider information, etc. This assistance is also inclusive of writing appeal letters that would be submitted to insurance for reconsideration of a denied claim.
• Provide advice and guidance to administrators, faculty, and staff as it relates to coding and documentation along with any third party payer regulations.
• Assist other coding staff in the unit to provide coverage as needed and assist in training other coders when requested.

Performs other duties as required or assigned which are reasonably within the scope of the duties described above.

Qualifications

Credentials to be Verified by Placement Officer

• High school graduation or equivalent.
• Any one or any combination totaling 18 months from the following categories:
• Work experience in a healthcare setting (i.e., hospital, physician’s office, nursing home, billing agency) utilizing ICD-10, and CPT coding systems, Healthcare Common Procedure Coding System (HCPCS), and the Current Procedural Terminology (CPT) systems of coding to assign codes for services provided to patients.
• College course work relating to healthcare operations includes the following topics such as Medical Terminology, Human Anatomy and Physiology, ICD-10 Coding, and CPT Coding, or closely related courses.
• 6 semester hours equals 6 months
• 12 semester hours equals 12 months
• 18 semester hours equals 18 months
• Current designation as Certified Professional Coder-Apprentice (CPC-A), Certified Professional Coder (CPC) or a Certified Outpatient Coder (COC) by the American Academy of Professional Coders (AAPC) (formerly CPC-H certification) or current certification as a Certified Coding Associate (CCA), Certified Coding Specialist (CCS) or Certified Coding Specialist-Physician-based (CCS-P) or Registered Health Information Technician (RHIT) or Registered Health Information Administrator (RHIA) by the American Health Information Management Association (AHIMA) satisfies all the requirements for this classification.

Knowledge, Skills & Abilities (KSA’s)

• Knowledge of medical terminology.
• Knowledge of ICD-10 and CPT coding systems and Healthcare Common Procedure Coding System (HCPCS), and the Current Procedural Terminology (CPT) coding systems.
• Maintains knowledge of national standards for coding accuracy and internal standards for productivity.
• Maintains CEU (Continuing Education Units) as dictated by certifying body.
• Maintains confidentiality of patient health information at all times.
• Analytical ability.
• Mathematical ability.
• Organizational ability.
• Ability to interact with a variety of persons, including medical providers and ancillary staff.

Condition of Employment

Out of State Applicants that apply to Springfield vacancies in classifications in the occupational area of Professional, Semi-Professional, or Managerial will be subject to the following Condition of Employment: Pursuant to the State University Civil Service System, an out-of-state resident who is hired into this position must establish Illinois residency within 180 calendar days of their start date.

Supplemental Information

If you require assistance, please contact the Office of Human Resources at [e-mail] or call 217-545-0223 Monday through Friday, 8:00am-4:30pm.

The mission of Southern Illinois University School of Medicine is to optimize the health of the people of central and southern Illinois through education, patient care, research and service to the community.

The SIU School of Medicine Annual Security Report is available online at https://www.siumed.edu/police-security . This report contains policy statements and crime statistics for Southern Illinois University School of Medicine in Springfield, IL. This report is published in compliance with Federal Law titled the "Jeanne Clery Disclosure of Campus Security Policy and Crime Statistics Act."

Southern Illinois University School of Medicine is an Affiliated Action/Equal Opportunity employer who provides equal employment and educational opportunities for all qualified persons without regard to race, color, religion, sex, national origin, age, disability, sexual orientation, protected veteran status or marital status in accordance with local, state and federal law.

Pre-employment background screenings required.