Posting Close Date:? September 15, 2023
On-Site Work – Not Remote
The Peds Reimbursement Coding Representative operates under the direct supervision the Director of Administrative Operations and indirect supervision of a Reimbursement Coding Specialist. They code standard diagnoses and medical services for the purpose of receiving maximum allowable reimbursement from payors. The position performs other coding related functions such as patient registration and review of coding, billing, and documentation issues. Duties & Responsibilities
- Codes standard charge documents for ancillary and physician services using standardized coding systems such as ICD-9-CM, ICD-10 and CPT, or verifies coding performed by clinical staff and lower level coders for accuracy. Completes data entry of paper billing claims into Epic when system does not allow for electronic charge entry. Processes all electronic & paper claims that are entered manually.
- Assists with submissions of additional documentation on individual claims to increase reimbursement levels and provide additional/supplementary documentation needed for payor consideration of non-routine charges. Reviews documentation in order to verify accuracy of codes, dates of service, and assures documentation supports codes. Communicates with physicians and ancillary personnel to resolve problems with specific charges. Verifies that demographic and insurance carriers are accurate within patient registration. Reviews Epic workques (Charge Review) and corrects all errors that are delaying claim submission. Reviews Epic workques & make corrections: Claim Edit & Denials workques. Contacts the clinics/departments to determine the correct code to submit for coding errors and makes necessary changes.
- Attends coding & reimbursement workshops to maintain level of competence & coding certification.
- Performs other related duties as assigned. Assists in the preparation of general coding reports as requested.
- High school graduation or equivalent.
- Any one or any combination totaling 18 months from the following categories:Work experience in a healthcare setting (i.e., hospital, physician’s office, nursing home, billing agency) utilizing ICD-10, and CPT coding systems, Healthcare Common Procedure Coding System (HCPCS), and the Current Procedural Terminology (CPT) systems of coding to assign codes for services provided to patients.College course work relating to healthcare operations includes the following topics such as Medical Terminology, Human Anatomy and Physiology, ICD-10 Coding, and CPT Coding, or closely related courses.6 semester hours equals 6 months12 semester hours equals 12 months18 semester hours equals 18 months Current designation as Certified Professional Coder-Apprentice (CPC-A), Certified Professional Coder (CPC) or a Certified Outpatient Coder (COC) by the American Academy of Professional Coders (AAPC) (formerly CPC-H certification) or current certification as a Certified Coding Associate (CCA), Certified Coding Specialist (CCS) or Certified Coding Specialist-Physician-based (CCS-P) or Registered Health Information Technician (RHIT) or Registered Health Information Administrator (RHIA) by the American Health Information Management Association (AHIMA) satisfies all the requirements for this classification.
The University of Illinois System is an equal opportunity employer, including but not limited to disability and/or veteran status, and complies with all applicable state and federal employment mandates. Please visit Required Employment Notices and Posters to view our non-discrimination statement and find additional information about required background checks, sexual harassment/misconduct disclosures, COVID-19 vaccination requirement, and employment eligibility review through E-Verify.
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