Detailed Job Description
The Medical Reimbursement Specialist will organize and facilitate the clinical precertification process by researching and reviewing information provided by physicians and determining the appropriate coding to be used.
Additional Department Summary:
The Medical Coding and Insurance Billing Specialist is responsible for supervises coding and data entry functions for maximum reimbursement of the Student Health Center's (SHC) providers and ancillary services. This position ensures that encounters are properly coded and are entered in a timely fashion by reviewing clinical notes, CPT and ICD codes, including ICD-9 and conversion to ICD 10, for accuracy and completeness prior to posting charges. . Maintains a working knowledge of coding rules and regulations and the associated resources available, as well as familiarity with appropriate modifier usage. Performs regular audits of charges/diagnoses to ensure compliance with regulations. Provides regular medical coding education to providers in collaboration with Medical Director and with attention to audits performed, changes in coding policies and requirements as indicated. Plans and assists in provider /biller meetings for QI purposes. Reviews and updates charge/billing documents on continuous basis within the Electronic Medical Record. Collaborates with the Medical Director, Director of Finance, IT Specialist and Director of Medical Records in various areas related to the clinical practice. Supervises the medical coders and insurance clerks, training and supporting their proficiency in dealing with over 70 health insurance companies covering students from all 50 states as well as international students.
Required Minimum Qualifications
High School Diploma or GED and 5 years of experience in the medical field with ICD-9 and CPT coding, billing and/or reimbursement experience; Associate's degree and 3 years of experience in the medical field with ICD-9 and CPT coding, billing and/or reimbursement experience; Bachelor's degree and 1 year of experience in the medical field with ICD-9 and CPT coding, billing and/or reimbursement experience.
Skills and Knowledge:
Extensive knowledge of ICD-9-CM and CPT-4 coding, medical terminology, basic anatomy and pathophysiology necessary to adequately review code diagnoses. Proficiency across a wide range of services, including evaluation and management (E&M) urgent and primary care service codes
Preferred to be a Certified Medical Coder. Minimum Associate Degree in Business Administration or Health Care. Completed training in ICD-10 and application. Excellent verbal and written communication. Strong interpersonal skills in interacting with a variety of health care professionals and staff. Strong work ethic. Based on Qualifications
Prior to hiring, the final candidate(s) must successfully pass a pre-employment background investigation. A prior conviction reported as a result of the background investigation DOES NOT automatically disqualify a candidate from consideration for this position. A candidate with a prior conviction will receive an individualized review of the prior conviction before a hiring decision is made. EOE/AA
The University of Alabama is an Equal Employment/Equal Educational Opportunity Institution. All qualified applicants will receive consideration for employment without regard to race, color, religion, national origin, sex, sexual orientation, age, genetic information, disability, or protected veteran status, and will not be discriminated against because of their protected status.