Under the direction of the Revenue Cycle Supervisor - Coding the Sr. Physician Coding Specialist monitors and analyzes unresolved third party accounts for multi-specialty group practices. This position initiates contact and negotiates appropriate resolutions to ensure timely payments of outstanding claims.
Essential Functions of the Position
1. 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.
2. Communicates with payors and other internal departments as required to obtain critical information that impacts the resolution of both current and future claims.
3. Researches and responds to all telephone inquiries from the customer service department, in a prompt, professional manner meeting departmental guidelines.
4. Reviews and corrects coding rejections.
5. May code ICD-9 from written documentation.
6. May abstract CPT/HCPCS codes.
7. May perform computer assisted coding functions.
8. In depth knowledge of coding rules and payer guidelines.
9. May code E/M services.
10. Top performer in department productivity.
11. Top performer in department accuracy.
12. May perform auditing functions.
13. May be assigned to complicated sub-specialties.
14. Trains/mentors new coders.
15. Assists staff when supervisor is not available.
16. Requires minimal supervision.
17. Effectively communicates coding trends and documentation requirements with physicians and practice managers.
18. Maintains patient/physician confidentiality at all times and maintains effective communication and professional interaction with patients and physicians.
19. Provides appropriate information and feedback to various personnel within UHPS. Supports and utilizes established departmental guidelines. Recommends additional research to other CBO departments.
20. Identifies trends with insurance related issues and reports findings to the Team Lead.
21. Acts as a role model for professionalism through appropriate conduct and demeanor at all times.
22. Interprets written correspondence and either resolves the problem or forwards it to another department for prompt resolution.
23. Effectively communicates utilizing the telephone, form letters or internal correspondence to resolve patient inquiries.
24. Handles multiple tasks simultaneously.
25. Must have an understanding of insurance products and billing requirements to effectively resolve discrepancies in billing statements.
26. Performs other related duties as assigned
1. Educational Requirements
High School diploma or equivalent required.
One of the following credentials required: CPC, CPC-H, CPC-P, CPC-A, CCS,
CCS-P, RHIT, RHIA, RCC, ROCC
2. Experience Requirements
Minimum of three years of medical coding experience required. Coding experience in a multi-specialty group is a plus.
3.Skills and Abilities
Excellent interpersonal skills to work in partnership with others to influence and gain cooperation. Ability to recognize, evaluates, and solves problems. Strong verbal and written communication skills. Extensive knowledge of the claims development process, as well as third party insurance program requirements. Must possess basic knowledge of ICD-9 and CPT coding. Ability to handle a variety of tasks with speed, attention to detail, and accuracy. Computer literate, experience with basic software packages.
Equal Opportunity Employer - minorities/females/veterans/individuals with disabilities/sexual orientation/gender identity.
Location/Region: Cleveland, OH (US - 44101)