Note: The following additional materials are also required for consideration: Coding certificate from AAPC or AHIMA Instructions for submission of these materials will be provided at the time the online application has been completed.
Serve as the department's coding, billing, payment posting, and insurance specialist with a vast knowledge and application of all aspects of insurance claims filing for services provided at UHS. Provides other complex administrative duties and support relative to filing of third-party insurance claims, cashiering, etc.
Processes payments from insurance reimbursements for services provided at UHS, which includes: posting payments from Explanation of Benefits received and process insurance correspondence; correct rejected claims and file claims for reconsideration; perform appeals processing tasks as required from insurance companies in time efficient manner; maintains a log of all checks received; researches unpaid claims; reviews insurance contracts as it related to claims payments. Ensures accurate, compliant and timely submission of insurance claims to provide accurate and efficient reimbursement, which includes: reviewing patient encounters for proper use of procedure and diagnostic codes/modifiers; utilizes CPT, ICD-9/10 and HCPCS manuals, and insurance policies to ensure accurate coding as been used to optimize reimbursement; reads and understands payor specific billing requirements as outlined in procedure manuals, payor newsletters and internal communication. Support coding and billing compliance program, such as: reviews codes and biling for appropriateness and accuracy; makes recommendations for code additions, deletions, or modification to update coding dictionary to comply with annual changes according to coding and insurance resources; participates in billing and coding audit process; participates in Coding and Charges Committee to assist with process improvements and optimize reimbursements. Trains staff as delegated by Manager to include departmental staff and UHS organization as needed; create training manuals for Cashier/Insurance office staff; provides training to new employees as delegated; provides coding, billing, and insurance training to clinicians and adminstrative staff. Serve as back-up Cashier as necessary. Serve as back-up Referral Specialist as necessary. Participates in other activities as appropriate and assigned, such as: facilitates insurance credentialing process for clinical staff; data enters patient insurance information from various sources including electronic queue; assists patients with form completion to lift bars; establishes patient payment plan contracts; processes subscription applications; performs Inter-Departmental Transactions as necessary; process patient billing and Bursar transactions. Exhibits exception customer service behavior and excelletn public relation skills in all aspects of work.
Understands and complies with all applicable UHS and UT policies and procedures as well as all applicable state and federal laws. Other related functions as assigned.
High School graduation or GED. Seven years of clerical experience. One year as certified medical coder, billing, and insurance specialist with coding certification from AAPC or AHIMA. A minimum of two years working in ambulatory family practice care setting performing medical coding, billing, and payment posting with electronic health records and electronic medical claims submissions. Demonstrated ability to successfully work with a diverse community and provide services from non-judgmental perspective. Equivalent combination of relevant education and experience may be substituted as appropriate.
More than one year as a certified medical coder, biller, and insurance specialist working in ambulatory family practice care setting performing medical coding, billing, and payment posting with electronic health records and electronic medical claims submissions.
May work around standard office conditions May work around biohazards Repetitive use of a keyboard at a workstation Use of manual dexterity Exposure to fumes, chemicals, sprays, and commercial items found in standard office conditions, medical clinics, and in repairs and maintenance.