Coding and Reimbursement Oversight Specialist

2 weeks ago


Springfield, Illinois, United States Southern Illinois University School of Medicine Full time

Salary:
$4,685.11 Monthly

Job Type:
Civil Service

Remote Employment:
Flexible/Hybrid

Department:
FQHC / Express Care-North Dirksen-SMS

Position Overview:
The primary objective of this advanced role is to oversee, guide, and evaluate all coding operations for the clinical divisions at SIU Medicine Express Care and SIU Federally Qualified Healthcare Center Decatur SIU Center for Family Medicine. This includes, but is not limited to: direct management of coding personnel, facilitating training and ongoing education for coding staff (RCR and RCS), clinical teams, and providers, conducting audits of clinical documentation in relation to CPT code selection, analyzing coding denials to support educational efforts for coding staff, and providing assistance, insights, and relevant training for both existing and new system implementations as well as compliance with federal and state regulations.

Key Responsibilities:
1. **Administration & Training**
- Interview, onboard, supervise, and assess all coding and billing personnel.
- Maintain productivity metrics for coding.
- Assist in the development and implementation of policies for the coding and billing unit based on payer types and special billing programs.
- Establish daily priorities for staff to ensure timely and accurate coding and billing for reimbursement.
- Stay informed about new developments and policy changes at national, state, and local levels, particularly concerning Medicaid and Medicare coding/billing for FQHCs.
- Investigate reimbursement rates and issues related to new services.
- Address billing inquiries from patients, faculty, and staff.
- Attend meetings to inform faculty and staff about new coding issues and recurring challenges.
- Identify potential compliance issues and report them accordingly.

2. **Direct Coding and Billing for Reimbursement**
- Provide expert guidance to administrators, faculty, and staff regarding coding, documentation, and third-party payer guidelines.
- Research and advise on new CPT and ICD-10 codes, including reimbursement rates and documentation requirements.
- Assist in resolving complex account issues related to coding and denials.
- Conduct periodic audits of chart notes to ensure all appropriate charges are billed.
- Review documentation to determine the appropriate level of services provided and ensure all procedures are captured for billing.
- Conduct training sessions on coding and billing guidelines based on audit outcomes.

3. **Miscellaneous Duties**
- Assist in posting charges as needed to meet submission goals.
- Attend seminars and read publications to enhance knowledge of coding and billing processes.
- Perform other duties as assigned.

Qualifications:
- High school graduation or equivalent.
- Current certification as a Certified Coding Specialist (CCS), Certified Coding Specialist-Physician-based (CCS-P), Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA), Certified Professional Coder (CPC), or Certified Outpatient Coder (COC).
- A minimum of three years of total work experience, with at least two years comparable to the Reimbursement Coding Specialist level or in other positions of similar responsibility.

Benefits:
- Includes 13 paid holidays per year.
- Paid sick time for personal illness or family emergencies.
- Health, Dental, and Life insurance options available.
- Tuition Waiver/Tuition Reimbursement for continued education.
- Employee Assistance Program for confidential support services.


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