Sr Physician Coding Specialist

University Hospitals; Shaker Heights (OH); On-site; USD 70,000 - 110,000; Full time

Job summary

University Hospitals in Ohio is seeking a Sr Physician Coding Specialist to monitor coder productivity, train, audit and code surgical encounters while serving as a resource for physicians and departments. You will analyze insurance accounts, communicate with payors, resolve coding rejections, and mentor staff.

The role requires CPC/CCS credentials and strong PHI compliance and problem-solving abilities. Travel up to 10% may be required.

Qualifications

• High School equivalent or GED is required.
• 3+ years of medical billing experience, with multi-specialty group experience preferred.
• Must possess CPC or CCS credentials as listed (or active CPC family).
• Basic knowledge of ICD-9 and CPT coding and PHI handling requirements.
• Excellent communication and problem-solving skills with attention to detail.

Responsibilities

• Analyzes outstanding insurance accounts daily and initiates follow-up.
• Communicates with payors and internal departments to obtain critical information.
• Responds to customer service inquiries promptly and professionally.
• Reviews and corrects coding rejections and may code ICD-9 from documentation.
• May abstract CPT/HCPCS codes and perform computer-assisted coding functions.
• Mentors and trains new coders; assists staff when supervision is unavailable.
• Communicates coding trends and documentation requirements with physicians and practice managers.
• Maintains PHI confidentiality and adheres to UH policies and procedures.

Skills

Interpersonal skills

Communication skills

Problem solving

Attention to detail

PHI compliance

Education

High School Equivalent / GED

CPC (any) CPC-H CPC-P CPC-A

CCS-P

RHIT

RHIA

RCC

ROCC

Job description

Job Description - Sr Physician Coding Specialist (260009ZB)

A Brief Overview

Under the direction of the Billing Supervisor - the Sr. Physician Coding Specialist monitors Coder Productivity, Train, Audit, Code Surgical Encounters, and be a Resource for Physicians and other Department within the system. Identifies trends with insurance related issues and reports findings to the Team.

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 rejections.
• May code ICD-9 from written documentation.
• May abstract CPT/HCPCS codes.
• May perform computer assisted coding functions.
• In depth knowledge of coding rules and payer guidelines.
• May code E/M services.
• Top performer in department productivity.
• Top performer in department accuracy.
• May perform auditing functions.
• May be assigned to complicated sub-specialties.
• Trains/mentors new coders.
• Assists staff when supervisor is not available.
• Requires minimal supervision.
• Effectively communicates coding trends and documentation requirements with physicians and practice managers.
• 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.

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.

Education

• High School Equivalent / GED (Required)

Work Experience

• 3+ years of medical billing experience (Required) and
• Billing experience in a multi-specialty group (Preferred)

Knowledge, Skills, & Abilities

• Excellent interpersonal skills to work in partnership with others to influence and gain cooperation. (Required proficiency)
• Ability to recognize, evaluates, and solves problems. (Required proficiency)
• Strong verbal and written communication skills. (Required proficiency)
• Extensive knowledge of the claims development process, as well as third party insurance program requirements. (Required proficiency)
• Must possess basic knowledge of ICD-9 and CPT coding. (Required proficiency)
• Ability to handle a variety of tasks with speed, attention to detail, and accuracy. (Required proficiency)
• Computer literate, experience with basic software packages. (Required proficiency)
• This role encounters Protected Health Information (PHI) as part of regular responsibilities. (Required proficiency)
• UH employees must abide by all requirements to safely and securely maintain PHI for our patients. (Required proficiency)
• Annual training, the UH Code of Conduct and UH policies and procedures are in place to address appropriate use of PHI in the workplace. (Required proficiency)

Licenses and Certifications

• Certified Professional Coder (CPC) (Required) or
• Certified Professional Coder (CPC) CPC-H (Required) or
• Certified Professional Coder (CPC) CPC-P (Required) or
• Certified Professional Coder (CPC) CPC-A (Required) or
• Certified Coding Specialist (CCS) CCS-P (Required) or
• Registered Health Information Technologist (RHIT) (Required) or
• Registered Health Information Administration (RHIA) (Required)
• RCC (Required) or
• ROCC (Required)

Physical Demands

• Standing Occasionally
• Walking Occasionally
• Sitting Constantly
• Lifting Rarely up to 20 lbs
• Carrying Rarely up to 20 lbs
• Pushing Rarely up to 20 lbs
• Pulling Rarely up to 20 lbs
• Climbing Rarely up to 20 lbs
• Balancing Rarely
• Stooping Rarely
• Kneeling Rarely
• Crouching Rarely
• Crawling Rarely
• Reaching Rarely
• Handling Occasionally
• Grasping Occasionally
• Feeling Rarely
• Talking Constantly
• Hearing Constantly
• Repetitive Motions Frequently
• Eye/Hand/Foot Coordination Frequently

Travel Requirements

• 10%