Physician / Surgical Claims Coding Specialist - Full-Time, Day

Job Description

Join UChicago Medicine Care Network, as a Revenue Claims Coding Specialist, UCM Care Network in the Burr Ridge, IL location. In this role you will primarily support Administrative Support Workers. This position will be primarily a work from home opportunity with the requirement to come onsite as needed. You may be based outside of the greater Chicagoland area.

 

Revenue Claims Coding Specialist (RCCS) works under the supervision of the Manager, Revenue Claims Coding Specialist. The RCCS team works collaboratively with Primary Healthcare Associates (PHA) physicians assigned to his/her team/group in order to provide an optimal revenue cycle environment that is efficient, effective, comprehensive and compliant. The RCCS team also works collaboratively with the PHA practice managers, billing staff and when needed, insurance payers to support a highly efficient, effective, and compliant revenue cycle program. The typical work includes the entry of professional charges from charge tickets into EPIC, resolution of coding edits for all payers, revenue reconciliation, identify and/or organize appropriate education for physicians. Effective communication with management, providers and practice directors will be key. The Revenue Claims Coding Specialist will also be responsible for the completion of all work assignments in a proficient and accurate manner; meeting productivity and quality standards set by the Revenue Claims Coding Specialist Manager.

 

Essential Job Functions

• Works directly with manager as assigned to charges from PHA providers for non-office based services, i.e. inpatient, outpatient surgery, dialysis and nursing home visits to facilitate charge entry, resolve coding and charging issues for all payers (NCCI, OCE, MUE, LCD, payer custom edits), including but not limited to denials and disputes
• Serves as a charging/coding resource supporting physician’s/provider’s revenue capture. As such, organizes charge tickets for timely entry into EPIC
• Review medical documentation for assigning billing modifiers to insurance claims where appropriate and applicable. Works assigned work ques daily with the goal to complete all assigned tasks
• Perform charge reconciliation and work with the physicians/providers and/or practice managers in instances of missing charges/ revenue
• Routinely communicates with manager and where possible, providers, practice administrators, billing staff and payers as needed to discuss clinical questions with respect to coding assignment or resolution of edits in a courteous and professional manner
• Provide appropriate feedback to manager and provider for education on trends identified from errors or payer denials
• Participate in meeting with provider, practice manager as assigned by manager to improve the overall claims, revenue cycle, and business functions of the practice
• Attends and participates in team meetings to discuss coding/charging issues and participates on projects as requested. Maintains current knowledge of all billing and compliance policies, procedures and regulations and attends appropriate training sessions as required
• Meets all productivity and quality expectations and participates in all scheduled audits and performs other duties as assigned

Required Qualifications

• Ability to identify trends and recommend solutions to billing and revenue cycle processes and problems
• Coding certification through AAPC or AHIMA required
• High school diploma
• Proven working knowledge of professional billing of CPT (Current Procedural Terminology) and ICD (International Classification of Diseases) coding systems 
• Knowledge of Federal billing regulations governing Medicare and Medicaid programs and working knowledge of other managed care and indemnity (third party) payer requirements
• Must possess a working knowledge of Local and National Coverage Determination policies (LCD’s and NCD’s), Ambulatory Payment Classification (APC) related edits such as the National Correct Coding Initiative (NCCI) and Outpatient Code Editor (OCE).
• Must be proficient in Microsoft Excel and Word
• Must be highly analytical and have excellent written and verbal communication skills

 

Preferred Qualifications

• Epic experience 
• Associate or bachelor’s degree in a health-care information or health care finance related field
• Prior experience with Provider E/M

 

Position Details

• Job Type/FTE: Full Time (1.0 FTE)
• Shift: Days
• Work Location: Flexible Remote/ Burr Ridge, IL
• Unit/ Department: Revenue Cycle
• CBA Code: Non