Clinical Reimbursement Specialist

1. Position Title: Clinical Reimbursement Specialist

2. SUMMARY OF DUTIES:
1. Maintains a working knowledge of CPT and ICD-9 coding principles, governmental regulations, protocols and third party requirements regarding billing and billing documentation.
2. Assures that all services documented in the patient’s chart are coded with appropriate CPT-4 and ICD-9 codes. When services are not documented appropriately, seeks to attain proper documentation in a timely manner.
3. Achieves and maintains a 95% accuracy in professional fee coding while maintaining a high level of productivity. Accuracy will be monitored by periodic reviews by Manager.
4. Conducts a review of patient hospital charts to insure compliance with coding and documentation guidelines and governmental requirements. Provides written reports to Manager and/or Director with results of these audits.
5. Conducts one-on-one or small group education to physicians regarding the results of their periodic reviews while maintaining an exceptionally high level of professionalism.
6. Provides accurate answers to physician’s coding and/or billing questions on a timely basis.
7. Maintains a working knowledge of the IDX billing system, the registration process and charge entry. May be required to input registration information and enter charges in the event of a backlog.
8. Works with other members of the Central Billing Office to assure maximum efficiency and reimbursement for properly documented services, both in the hospital inpatient and outpatient setting.
9. Establishes and maintains a professional working relationship with staff including registry staff, nursing unit staff, physicians and medical records.
10. Provides reports and analysis of inpatient coding and billing as requested by Manager or Director of Finance.
11. Reviews, modifies, and recommends changes to policies and procedures to improve professional fee coding and data management.
12. Other duties as assigned by Manager.
3. Machines, Tools, Equipment Operated:

Telephone, copier, adding machine, IDX computer system terminal and IBM personal computer, including word processing and spreadsheet software.

4. Education and Training:

College degree preferred. CPC credential required. Knowledge of CPT-4 and ICD-9 coding required. Knowledge of medical terminology and abbreviates required.

5. Experience:

2 to 3 years experience in physician fee coding. Broad based knowledge of services provided to patients in a hospital setting. Knowledge of computerized billing system, specifically IDX, preferred. Knowledge of billing regulations, insurance coverage limitations and managed care protocols preferred. Experience providing one-on-one feedback to physicians preferred.

6. Initiative, Judgment and Creative Ability:

Proven analytical and organizational ability. Proven ability to work with minimal supervision at a high level of productivity. Must be able to communicate both verbally and in writing in a highly professional manner. Must be able to prioritize own work and proceed with a minimum of supervision. Confidential patient, financial and employee information must be protected according to institutional policy.

7. Mental, Visual and Hearing Demand:

Position requires close attention to detail and ability to handle multiple tasks simultaneously, telephone and face-to-face contact with other staff and external contacts, viewing a computer monitor and reading computer-printed reports, and ability to meet deadlines and work with frequent interruptions. Continuous attention to detail required. Must be able to function under pressure.

8. Reports and Records:

Access to highly confidential information and reports including utilization and reimbursement reports and patient charts.

9. Contacts:

Patients, physicians, other hospital employees, outside insurance carriers as well as billing office staff and other employees.

 

10. Comments:

Ability to work independently and as part of a team is critical. Must have excellent command of the English language. Must be punctual and maintain an excellent attendance record. Ability to maintain professional attitude at all times. Incumbent must consistently adhere to department standards for professional office environment. Must be articulate, mature and highly organized.