The Physician Coding Specialist II analyzes and resolves outstanding insurance accounts for multi-specialty group practices. They communicate with payors and internal departments to ensure timely claim payments while maintaining strict confidentiality of patient information.
A Brief Overview
Under the direction of the Revenue Cycle Supervisor - Coding the Physician Coding Specialist II 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.
What You Will Do
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.
Communicates with payors and other internal departments as required to obtain critical information that impacts the resolution of both current and future claims.
Researches and responds to all telephone inquiries from the customer service department, in a prompt, professional manner meeting departmental guidelines.
Reviews and corrects coding edits and denials.
May code ICD-10 from written documentation.
May abstract CPT/HCPCS codes.
May perform computer assisted coding functions.
Working knowledge of coding rules and payer guidelines.
Consistently meets department productivity standards
Consistently meets department quality standards.
Maintains patient/physician confidentiality at all times and maintains effective communication and professional interaction with patients and physicians.
Provides appropriate information and feedback to various personnel within UHPS. Supports and utilizes established departmental guidelines. Recommends additional research to other CBO departments.
Identifies trends with insurance related issues and reports findings to the Team Lead.
Acts as a role model for professionalism through appropriate conduct and demeanor at all times.
Interprets written correspondence and either resolves the problem or forwards it to another department for prompt resolution.
Effectively communicates utilizing the telephone, form letters or internal correspondence to resolve patient inquiries.
Handles multiple tasks simultaneously.
Must have an understanding of insurance products and billing requirements to effectively resolve discrepancies in billing statements.
Performs other related duties as assigned.
This role will encounter Protected Health Information (PHI) as part of regular responsibilities. UH employees must abide by all requirements to safely and securely maintain 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.
Additional Responsibilities
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.
Education
High School Equivalent / GED (Required)
Work Experience
2+ years Of medical billing experience (Required) and
Billing experience in a multi-specialty group is a plus. (Preferred)
Knowledge, Skills, & Abilities
Excellent interpersonal skills to work in partnership with others to influence and gain cooperation. (Required proficiency)
Ability to recognize, evaluates, and solves problems. (Required proficiency)
Strong verbal and written communication skills. (Required proficiency)
Extensive knowledge of the claims development process, as well as third party insurance program requirements. (Required proficiency)
Must possess basic knowledge of ICD-9 and CPT coding. (Required proficiency)
Ability to handle a variety of tasks with speed, attention to detail, and accuracy. (Required proficiency)
Computer literate, experience with basic software packages.
Licenses and Certifications
Certified Professional Coder (CPC) CPC-A, CPC-H, or CPC-P (Required) or
Certified Coding Specialist (CCS) or CCS-P (Required) or
Registered Health Information Technologist (RHIT) (Required) or
Registered Health Information Administration (RHIA) (Required)
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