Position responsible for submitting and resolving coding denials/edits for moderate to high complexity medical claims. Must remain current with governmental and third party billing, follow-up and appeal requirements for compliant billing and follow-up of both inpatient and outpatient claims for all wholly owned facilities and physician entities including internal and external policy requirements. This includes the handling of specialty billing claims, escalated accounts receivable concerns, and special projects for the health system.

Essential Functions

• Reviews and corrects coding rejections from payers and edits.
• May code or correct CPT and/or ICD-10 from written documentation
• May abstract CPT/HCPCS codes from provider documentation
• May perform computer assisted coding functions.
• Applies in depth knowledge of coding rules and payer guidelines
• May code E/M services.
• May be assigned to complicated sub-specialties.
• Provides coding education/feedback to physicians and departments.
• Responds to requests from management, staff, or physicians in a timely and appropriate manner.
• Maintains patient and physician confidentiality and professionalism at all times.
• Follows department policies and procedures to ensure accurate and timely claim resolution.
• Effectively communicates utilizing telephone, form letters, e-mail, or internal correspondence to resolve patient inquiries and insurance issues.
• Attends and participates in team meetings.
• Utilizes work lists to review and analyze account balances in order to collect payment for medical services rendered.
• Utilizes multiple system applications to review and update patient billing information.
• Acts as a liaison with internal and external customers providing assistance in claims and receivables resolution in a high volume environment.
• Performs follow up with insurance companies to ensure appropriate payment on claims, resolve denials, correct claims, and appeal claims.
• Contacts patients and guarantors to secure necessary billing information.
• Documents accounts with clear and concise verbiage in accordance with departmental procedures.
• Reviews and responds to correspondence and inquiries received.
• Serves as subject matter expert and primary go to person for questions from junior level staff.
• Perform training and creates process documentation.
• Assists management with special projects.
• In absence of management, may lead work flow efforts.
• Participates in or leads payer and/or departmental meetings as needed.
• Responsible for providing feedback suggestions and process improvement recommendations to management.
• Meets and exceeds team productivity and quality standards.
• Functions independently to analyze and resolve claims.
• Creates Excel spreadsheets to analyze and resolve claims.
• Performs other duties as assigned.

Required For All Jobs

• 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.