Reimbursement/Coding Specialist - Business Office Administration , USA Health Shared Services

USA Health Systems; Mobile (AL); Vor Ort; USD 40.000 - 60.000; Vollzeit

Zusammenfassung

USA Health in Mobile, AL is hiring a Billing and Coding Specialist to manage the reimbursement program, ensure compliance with current payment methodologies, and support accurate coding across Medicare, Medicaid, and commercial payers. You will monitor payer requirements and communicate updates to departments to minimize denials and maximize compliant reimbursement.

You will analyze denial patterns, assist with appeals, train staff, and collaborate with clinical teams to streamline processes,

Qualifikationen

• High School Diploma or equivalent and 2 years of medical and coding experience required.
• Certification as a Certified Professional Coder within 1 year required.
• Comparable education/experience may substitute for the above requirements.

Aufgaben

• Coordinate and maintain the reimbursement program to ensure compliance with payment methodologies and regulations.
• Monitor Medicare, Medicaid and commercial payer requirements related to documentation, coding, and reimbursement.
• Track regulatory changes affecting billing, collections and reimbursement.
• Communicate billing, coding and reimbursement changes to clinical departments and managers.
• Assist in using CPT, ICD-10-CM, HCPCS for maximum compliant reimbursement.
• Identify and improve processes related to billing, collections, charge capture and reporting.
• Identify adverse trends and recommend corrective actions.
• Identify missed charges and support reimbursement recovery.
• Review third-party payer denials and assist with denial resolution and recovery.
• Assist with appeals when reimbursement is denied.
• Provide reimbursement trend analyses to managers.
• Maintain claim edits and work queues in the practice management system.
• Train new personnel on charge capture and billing requirements.
• Participate in departmental meetings to communicate policy and regulatory changes.
• Maintain knowledge of current reimbursement methodologies and payer requirements.
• Complete all mandatory department and hospital requirements.
• Adhere to Infection Control and Safety Standards.
• Regular attendance and ability to work overtime.
• Related duties as assigned.

Kenntnisse

Billing

Coding

Regulatory compliance

Communication

Ausbildung

High School Diploma or equivalent

Certified Professional Coder (CPC) within 1 year

Jobbeschreibung

Overview

USA Health is Transforming Medicine along the Gulf Coast to care for the unique needs of our community. USA Health is changing how medical care, education, and research impact the health of people who live in Mobile and the surrounding area. Our team of doctors, advanced care providers, nurses, therapists, and researchers provides the region's most advanced medicine at multiple facilities, campuses, clinics, and classrooms. We offer patients convenient access to innovative treatments and advancements that improve the health and overall well-being of our community.

Responsibilities

• Assists In coordinating and maintaining the reimbursement program for USA Health System to ensure compliance with current payments methodologies, regulatory requirements and legislative regulations that Impact the billing and collections process;
• Monitor Medicare, Medicaid and commercial insurance carrier requirements related to documentation, coding, medical necessity and reimbursement.
• Monitors legislative and regulatory changes that may affect billing, collections, and reimbursement.
• Communicate billing, coding and reimbursement changes to clinical departments, HIM, Pre-services, and department managers and directors.
• Assist in determining the appropriate use of CPT, ICD-10-CM, HCPCS and other coding to maximize compliant reimbursement.
• Assist in identifying, developing and improving processes related to billing, collections, charge capture, and reporting.
• Assist in identifying adverse trends, operational issues, and recommended corrective actions.
• Identify missed professional and technical charges and support recovery of appropriate reimbursement.
• Reviews third-party payer denials, researches reimbursement issues, and assists with denial resolution and reimbursement recovery involving coding, documentation, payer requirements, and system configuration.
• Assist in reviewing and preparing appeals when reimbursement is denied.
• Assist with providing reimbursement trends and pattern analyses to managers and directors.
• Working claim edits and work queues within the practice management system.
• Assist in training new personnel on charge capture, reimbursement processes, and billing requirements, and provides ongoing education related to coding, billing, and reimbursement practices.
• Participating in departmental meetings to communicate policy, process, regulatory, and compliance changes.
• Maintains knowledge of current reimbursement methodologies, payer requirements, and revenue cycle best practices.
• Completes all mandatory department, educational and hospital requirements
• Adheres to current Infection Control and Safety Standards
• Regular and prompt attendance
• Ability to work schedule as defined and overtime as required
• Related duties as assigned

Additional Information

Employees must be in a regular position, working 20 hours or more per week (.50 FTE or greater) to qualify for benefits.

Qualifications

• High School Diploma or equivalent and 2 years of medical and coding experience Required
• Certification as a Certified Professional Coder within 1 Year Required
• Comparable combination of education and experience may substitute for the above requirements.