Reimbursement Spec

Responsible for policies and protocols related to coding and billing to ensure compliance. Creates, revises, and maintains departmental charge documents for professional and technical charges. Assists with onboarding and monitoring of new physicians.Pre-submission audit of provider's coding/documentation, monitor Professional Fee Coders and Billing/Charge Reconciliation Specialist activities to ensure accountability for all services performed and compliant billing and internal standards are met. Responsible for identification of opportunities and efficiencies in business office functions and operations. Patient accounts receivable management and denial analysis. Monitors departmental accounts receivable to achieve appropriate reimbursement percentages and maintain financial stability within the department. Analyzes accounts receivable to identify inequities in payment; collaborate with CCF contract management for resolution of payment issues. Conducts revenue-reporting analysis of costs associated with performing examinations and surgical/medical procedures and recommends fee modifications. Maintains departmental charge master files and performs ongoing reviews of professional and technical charges per compliance guidelines. Administration of responsibilities associated with departmental expansion. Assists in practice startup, new service lines and affiliate programs to ensure corporate compliance adherence to capture appropriate revenue. To include finance accounting and revenue mapping of billable services. Research analysis, IDE compliance and billing follow up. Other duties as assigned.

EDUCATION: High School Diploma or GED required. Computer literacy and Microsoft office products with emphasis on spreadsheets and word processing applications. Medical terminology and anatomy/physiology courses, ICD9 and CPT coding experience required.

LICENSURE/CERTIFICATION/REGISTRATION: One of the following certifications is required Certified Professional Coder (CPC) or Certified Coding Specialist Physician (CCS-P) or Registered Health Information Technologist (RHIT) or Registered Health Information Administrator (RHIA) or Certified Coding Associate (CCA) by American Health Information Management Certification (AHIMA) or Radiology Certified Coder (RCC).

COMPLEXITY OF WORK: Requires critical thinking and analytical skills, decisive judgment and the ability to work with minimal supervision. Applicant must be able to work under pressure to meet imposed deadlines and take appropriate actions.

REQUIRED EXPERIENCE: Minimum four years extensive CPT and ICD 9 CM coding and medical billing and reimbursement experience. Understanding and applying third party and government payer regulations. Experience providing education and trend analysis related to revenue and reimbursement.

PHYSICAL REQUIREMENTS: Manual dexterity to operate office equipment. Ability to lift and transport up to 15 pounds. May require extended periods of standing, walking or sitting. Good visual acuity through normal or corrected vision.

PERSONAL PROTECTIVE EQUIPMENT: Follows Standard Precautions using personal protective equipment as required for procedures. MEDICAL STAFF APPROVAL: