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

USA Health; Mobile (AL); On-site; USD 50,000 - 70,000; Full time

Job summary

USA Health in Mobile, AL seeks a Billing/Coding Specialist to support reimbursement workflows across Medicare, Medicaid, and commercial payers. You will ensure accurate documentation, coding, and compliant billing, while collaborating with clinical departments and billing teams.

The role requires CPC certification within 1 year and at least 2 years of medical coding experience, with a high school diploma or equivalent. We offer a collaborative work environment and benefits.

Qualifications

• High School Diploma or equivalent.
• 2 years of medical coding experience.
• CPC certification within 1 year required.

Responsibilities

• Coordinate and maintain the reimbursement program to ensure compliance with payer requirements.
• Monitor Medicare, Medicaid and commercial insurance carrier requirements for documentation, coding and reimbursement.
• Identify coding issues and assist in denial resolution and appeals.
• Communicate billing changes to clinical departments, HIM, and managers.
• Support training of staff on charge capture and reimbursement practices.
• Maintain knowledge of current reimbursement methodologies and best practices.

Skills

Medical coding

CPT coding

ICD-10-CM coding

HCPCS coding

Communication skills

Education

High School Diploma or equivalent

Certified Professional Coder (CPC)

Job description

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.

Equal Employment Opportunity/Affirmative Action Employer

The University of South Alabama is an Equal Opportunity Employer and does not discriminate on the basis of race, color, national origin, sex, pregnancy, sexual orientation, gender identity, gender expression, religion, age, genetic information, disability, protected veteran status or any other applicable legally protected basis. EO Employer – minorities/females/veterans/disabilities/sexual orientation/gender identity.