Claims Coding Specialist
2 weeks ago
**Job Description**:
Join a world-class academic healthcare system, UChicago Medicine, as a **Claims Coding Specialist (CCS) **in our** Revenue Cycle - Revenue Integrity **Department. This is a hybrid/flexible remote position and may require some on site requirement as needed. The office location is at the UChicago Medicine main campus in **Hyde Park, IL.**
**Hybrid Remote Opportunity**
**Job Summary**:
The Claims Coding Specialist (CCS) works under the supervision of the Revenue Integrity. The CCS team works collaboratively with physicians, assigned to his/her team/group in order to provide an optimal revenue cycle environment that is efficient, effective, comprehensive and compliant. The CCS team also works collaboratively with the ambulatory practice managers, billing staff and (at times) insurance payers to support a highly efficient, effective, and compliant revenue cycle program. The typical work includes the resolution to coding edits for all payers, revenue reconciliation, identify and/or organize appropriate education for physicians, and effective communication. The 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 Integrity Director. The Claims Coding Specialist reports directly to the Revenue Integrity Manager.
**Essential Job Functions**:
- Works directly with the hospital departments and ambulatory clinics to resolve coding and charging issues for all payers (NCCI, OCE, MUE, LCD, payer custom edits), including but not limited to denials and disputes.
- 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.
- Serves as a primary resource supporting in-clinic physicians/providers. As such, organizes appropriate education for physicians and communicates regularly with physicians/providers to improve the overall claims, revenue cycle, and business functions of the practice. utinely communicates with medical staff, practice administrators, billing staff and payers as needed to discuss clinical questions with respect to coding assignment or resolution in a courteous and professional manner.
- Meets regularly with the practice manager and medical director to review in-clinic revenue cycle performance and to identify appropriate solutions for advancing an efficient, effective, and compliant revenue cycle program.
- Perform charge reconciliation and work with the physicians/providers and/or practice managers in instances of missing revenue; with the optimal goal of ensuring the missing revenue gets posted and realized.
- Assist with identifying trends and opportunities to address root causes, updates systems and/or provider feedback/education/training.
- Maintains current knowledge of all billing and compliance policies, procedures and regulations and attends appropriate training sessions as required.
- Assist with orientation of newly hired Claims Coding Specialists.
- Attends and participates in team meetings to discuss coding/charging issues and serves on task forces as needed.
- Meets all productivity and quality expectations and participates in all scheduled audits.
- Performs other duties as requested by management.
**Required Qualifications**:
- Coding certification required within 3 months of hire: Health Information Management or Coding certification required within three months of hire: RHIA (Registered Health Information Administrator), RHIT (Registered Health Information Technician), CPC (Certified Professional Coder), COC (Certified Outpatient Coder), CCS (Certified Coding Specialist), CCS-P (Certified Coding Specialist Physician), or CCA (Certified Coding Associate)
- Epic, IDX and Centricity experience strongly preferred
- High school diploma required. Associate or Bachelor’s degree in a health-care information or health care finance related field preferred.
- Ability to identify trends and recommend solutions to billing and revenue cycle processes and problems
- Proven working knowledge of CPT (Current Procedural Terminology) and ICD (International Classification of Diseases) coding systems required.
- Knowledge of Federal billing regulations governing Medicare and Medicaid programs, and working knowledge of other managed care and indemnity (third party) payor 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,
- Must possess excellent organizational, time management and multi-tasking skills, along with demonstration of excellent interpersonal skills.
**Pr
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