Claims Coding Specialist

Job Description

Description

Become part of an inclusive organization with over 40,000 diverse employees, whose mission is to improve the health and well-being of the unique communities we serve.

Summary:
Performs complex duties in support of reimbursement from patients and insurance carriers for assigned clinical department. Duties include reversing denials from carriers, recoding denied claims, and identifying coding trends. Substantial knowledge of all carrier policies, procedures and practices is required to collect carrier accounts receivable, reverse denials, and expedite coverage to the uninsured. In addition, work requires knowledge of coding but not to the extent of classes in the Medical Coder series.

Responsibilities:
1. Collaborates with internal staff and Clinical departments regarding filing, documentation and reimbursement issues. Works closely with clinic staff to modify documentation, filing processes, and encounter forms to enhance billing and collection process
2. Evaluates accounts, billing, payments, coding, and posting of accurate charges for a highly specialized and complex medical service such as transplant. Researches and resolves denied claims with carrier and patients.
3. Identifies coding trends that do not support maximum reimbursement. Makes recommendations that will prevent or correct identified coding errors
4. May serve as a lead worker to provide problem resolution and assistance to lower level positions.
5. Researches and determines if carrier denial of claim is valid and if not, abstracts information from medical records to support appeal of carrier denials. Makes changes to original coding of charges in accordance with ICD-9 and CPT codes.
6. Serves as a resource for physicians, insurance carriers and patients to resolve questions/problems pertaining to patient accounts.

Other Information

Other information:
Education Requirements:
● High School diploma or GED
Licensure/Certification Requirements:
● No licensure or certification required.
Professional Experience Requirements:
● Three (3) years of experience in a clerical, accounting or customer service setting.
● Six (6) months of experience working with CPT and ICD-10.
Knowledge/Skills/and Abilities Requirements:

Job Details

Legal Employer: NCHEALTH

Entity: Johnston Health

Organization Unit: Business Office

Work Type: Full Time

Standard Hours Per Week: 40.00

Work Schedule: Day Job

Location of Job: US:NC:Smithfield

Exempt From Overtime: Exempt: No

This position is employed by NC Health (Rex Healthcare, Inc., d/b/a NC Health), a private, fully-owned subsidiary of UNC Heath Care System. This is not a State employed position.

Qualified applicants will be considered without regard to their race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

UNC Health makes reasonable accommodations for applicants' and employees' religious practices and beliefs, as well as applicants and employees with disabilities. All interested applicants are invited to apply for career opportunities. Please email [email protected] if you need a reasonable accommodation to search and/or to apply for a career opportunity.