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Claims Coding Specialist - Hemophilia Treatment Center

This job posting is no longer active.

Job ID: 10150
Location: Chapel Hill, NC
Facility/Division: UNC Faculty Physicians
Status: Full Time
Shift: Day Job

Did you know UNC Health has Ranked #2 Most Trusted Healthcare Brand in the U.S.? The UNC Health brand was ranked as the #4 healthcare brand in the United States overall and the #2 most trusted healthcare brand, just after Johns Hopkins and before Mass General. Join our One-Great-Team!

Job Description

Description

The UNC Hemophilia Treatment Center (HTC) Pharmacy provides specialty medications and supplies for patients with bleeding disorders. The program supports federally funded, comprehensive HTCs within North Carolina by providing clinical, nursing, educational, and financial services and expertise.

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.

POSITION DESCRIPTION: Primary purpose of this position will be to perform all functions necessary to support the program using systems and processes in a consistent, reliable manner.

  1. Contact appropriate payer sources upon receipt of each new referral into the pharmacy program in order to verify insurance eligibility coverage and to determine benefits, out-of- packet, deductibles, and co-payments.
  2. Advise the patient and/or responsible party of their financial obligation. The same systems will be used to verify coverage at least monthly and more often, if necessary to ensure eligibility of patient benefits and to best assure payment for service.
  3. Be skilled and proficient in preparing specialty pharmacy claims for submission either in electronic or paper format to maximize cash flow and minimize denials; verify the signing and dating of packing lists and will review them for accuracy to the actual receipt of product/supplies. Reviewing invoices prior to matching to packing lists and verifying accuracy of costs prior to submission to Materials & Disbursement via the FRS system.
  4. Be responsible for tracking and analyzing payments of claims and co-payment and will apply the receipt of payment(s) in the Accounts Receivables module within the pharmacy software. Maximizing opportunities for discounts by using prompt payments. Working the appropriate departments (i.e., SPO, etc.) to execute effective service agreements (ex., distribution projects, contract pharmacy agreements).

ESSENTIAL SKILLS: An strong accounting background, willingness to learn, strong problem-solving skills, demonstrated ability to independently complete tasks with minimal instruction and strong organizational skills are required for this position.

Responsibilities:

  1. Collaborates with internal staff, clinical departments 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. 3. 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. 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.
  5. 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: STATE

Entity: UNC Faculty Physicians

Organization Unit: Hemophilia Treatment Center 

Work Type: Full Time

Standard Hours Per Week: 40.00

Work Schedule: Day Job

Location of Job: US:NC:Chapel Hill

Exempt From Overtime: Exempt: No



This is a State position employed by UNC Health Care System.
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