Risk Adjustment Coding Specialist supporting risk adjustment efforts through chart reviews and provider education. Estimated travel up to 75% in Inland Empire region, specifically LA or Orange County.
About the role
- Physician Coding Specialist II responsible for resolving outstanding insurance accounts for multi-specialty group practices. Role involves analyzing insurance claims and communicating with payors in a professional manner.
Responsibilities
- Analyzes, on a daily basis and in accordance with established time frames, the outstanding insurance accounts
- Initiates appropriate and effective telephone and/or written follow-up on the identified accounts
- Communicates with payors and other internal departments as required to obtain critical information that impacts the resolution of both current and future claims
- Researches and responds to all telephone inquiries from the customer service department, in a prompt, professional manner meeting departmental guidelines
- Reviews and corrects coding edits and denials
- May code ICD-10 from written documentation
- May abstract CPT/HCPCS codes
- May perform computer assisted coding functions
- Consistently meets department productivity standards
- Consistently meets department quality standards
- Provides appropriate information and feedback to various personnel within UHPS
- Supports and utilizes established departmental guidelines
- Recommends additional research to other CBO departments
- Identifies trends with insurance related issues and reports findings to the Team Lead
- Acts as a role model for professionalism through appropriate conduct and demeanor at all times
- Interprets written correspondence and either resolves the problem or forwards it to another department for prompt resolution
- Effectively communicates utilizing the telephone, form letters or internal correspondence to resolve patient inquiries
- Handles multiple tasks simultaneously
- Must have an understanding of insurance products and billing requirements to effectively resolve discrepancies in billing statements
- Performs other related duties as assigned
Requirements
- High School Equivalent / GED (Required)
- 2+ years of medical billing experience (Required)
- Billing experience in a multi-specialty group is a plus (Preferred)
- Excellent interpersonal skills to work in partnership with others to influence and gain cooperation (Required proficiency)
- Ability to recognize, evaluates, and solves problems (Required proficiency)
- Strong verbal and written communication skills (Required proficiency)
- Extensive knowledge of the claims development process, as well as third party insurance program requirements (Required proficiency)
- Must possess basic knowledge of ICD-9 and CPT coding (Required proficiency)
- Ability to handle a variety of tasks with speed, attention to detail, and accuracy (Required proficiency)
- Computer literate, experience with basic software packages
- Certified Professional Coder (CPC) CPC-A, CPC-H, or CPC-P (Required)
- Certified Coding Specialist (CCS) or CCS-P (Required)
- Registered Health Information Technologist (RHIT) (Required)
- Registered Health Information Administration (RHIA) (Required)
- RCC (Preferred)
- ROCC (Preferred)
Benefits
- Maintains patient/physician confidentiality at all times
- Annual training, the UH Code of Conduct and UH policies and procedures are in place to address appropriate use of PHI in the workplace
- Complies with all policies and standards
Job title
Job type
Experience level
Salary
Not specified
Degree requirement
Location requirements
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