What are the responsibilities and job description for the Coding Reimbursement Specialist III position at TALENT Software Services?
Job Summary
The primary responsibility is to work with various departments within the Central Business Office to ensure appropriate reimbursement. The role involves handling ETM Specialty view requiring complex questions and research. Additional duties include completing special projects and reports while assisting PFS specialists, Patient Account Representatives, and Patient Accounting management with various coding or reimbursement-related issues. Collaboration with coding consultants and corporate compliance is also required.
Essential Functions
An Associate's degree and seven years of related experience are required. CPC certification is preferred, along with 2-3 years in billing reimbursement and/or patient accounting.
The primary responsibility is to work with various departments within the Central Business Office to ensure appropriate reimbursement. The role involves handling ETM Specialty view requiring complex questions and research. Additional duties include completing special projects and reports while assisting PFS specialists, Patient Account Representatives, and Patient Accounting management with various coding or reimbursement-related issues. Collaboration with coding consultants and corporate compliance is also required.
Essential Functions
- Answer various coding questions based on denials received at the CBO and work with training staff to educate accordingly.
- Collect and analyze data to identify reimbursement-related problems, such as denial trends, assessing cause and scope.
- Research and solve questions/issues related to the coding of accounts to determine the viability of collecting on claims.
- Assist various CBO departments in creating or appealing letters as appropriate, and track appeals to determine effectiveness.
- Compile and report data on various coding-related issues as they pertain by payer, sharing with MHR and Coding Support/Compliance as necessary.
- Attend CBO departmental, payor, and denial meetings as necessary.
- Analyze significant Accounts Receivable trends and communicate findings to management.
- Analyze denials received from third-party payers, define contributing factors, and recommend process improvements to decrease denials and ensure ongoing quality.
- Review medical records for correct coding.
- Experience with clinical practice in their medical specialty.
- Progressive experience as a physician leader or physician executive.
- Experience with training and educating clinical staff on EMR system use.
An Associate's degree and seven years of related experience are required. CPC certification is preferred, along with 2-3 years in billing reimbursement and/or patient accounting.
