Coder Reimbursement Specialist - Hospital

Coder Reimbursement Specialist - Hospital

Full‑time position. The Coding and Reimbursement Specialist (CCS) is responsible for coding and abstracting clinical data from the medical record, including inpatient, outpatient, commercial, Medicare, Medicaid, Illinois Public Aid, and all other payor types. Accurate and timely coding is essential for reimbursement to the hospital, according to the appropriately selected principal diagnosis and DRG in accordance with rules and regulations and coding methodologies, resulting in reimbursement and billing compliances as set forth by the Office of Inspector General.

The CCS manages workload, assigns work to three inpatient and two outpatient coders, and oversees day‑to‑day operations of the coding/reimbursement area. The CCS monitors regulatory sources to keep HIM coding and other staff informed and trained on coding rules, regulations and related issues, works closely with patient financial services to resolve claim denials, assists in updating the charge master, educates physician staff on documentation requirements to support E/M codes assigned to claims, audits coding accuracy, and participates in various medical center billing, coding and compliance groups.

The CCS works closely with physicians to document and interpret patient care, collaborates with the Director in hiring, firing and evaluating coding staff, and has input into systems and process changes. This position is directly related to the reimbursement the institution receives through skill, accuracy and job knowledge. The CCS must be proficient in CPT, ICD‑9‑CM, E/M coding methodologies, the DRG and APC reimbursement systems, and is accountable for maintaining the accounts receivable in the 50s.

Other Skills and/or Knowledge

Required:

Proficient in CPT, ICD‑9‑CM, E/M coding methodologies and the DRG and APC reimbursement system. Must be able to teach, train, work with various coding systems, write and express ideas well in updating procedure manuals, and comply with coding compliance and guidelines.

Codes diagnoses and procedures using ICD‑9‑CM, CPT, E/M coding methodologies. Must be extremely proficient in all areas of coding and coding compliance and processes; code all types of patient records according to payor, Medicare, commercial, Medicaid, Illinois Public Aid and any payor types. Carefully sequences principal and secondary diagnoses for appropriate and compliant reimbursement, reviews records thoroughly, tests interpretations, and processes using the encoder software to determine the most appropriate reimbursement.

Adheres to rules and regulations and guidelines of payors such as Medicare and Medicaid.

APC reimbursement system – monitors systems and processes and is knowledgeable with the APC reimbursement system. Works with IS, business office, HIM staff, and ancillary departments to facilitate information needed for coding and billing appropriately. Works closely with medical staff and leadership to meet documentation and coding policy requirements.

Process payor record – maintains daily interaction with coding staff to process all types of payor records, manages staff development through evaluations, interviews, hiring, discipline, terminations, and continuing education. Responsible for accounts for follow‑through, benchmarks from the HARA report, and maintaining communication with business office managers for timely billing and payment.

Compliance – responsible for self and staff compliance with government regulations, guidelines, facility policy and procedure, and coding compliance for billing. Act as liaison with managers, business office, and patient account representatives. Works on data analysis for DRG/APC projects.

Informing Director – keeps the Director updated on important matters, leads and mentors staff, writes and updates procedure manuals, and lists educational sources for coding guidelines and principal diagnosis selection.

ER evaluation and management coding – works with emergency department physicians for appropriate documentation, generates productivity and quality reports, conducts quarterly audits of coding functions and staff, reviews HCFA rules and regulations, and addresses internal compliance and non‑coding issues.

Selects appropriate assignments from the work queue, uses the encoder, ICD‑9‑CM and CPT-5 coding systems to code diagnosis and procedures accurately for all patient encounters, abstracts statistical data, contacts physicians or ancillary departments for additional information, and ensures high accuracy in coding, sequencing, and logs. Meets minimum productivity requirements.

CCS Certification.

3+ years of recent hospital‑based coding in all systems.

Job Status:
Full Time

Eligibility: EAD GC/ GC/ US Citizen

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