"Reimbursement Coding Specialist (U) (4840)"

The primary purpose of this position is to be responsible for ICD-10 and CPT coding of services provided by physicians and mid-level providers for all outpatient and inpatient services for the SIU Center for Family Medicine. This position reviews charges to ensure documentation is appropriate for the CPT level of service indicated. In addition, the employee is responsible for ensuring that the Teaching Physician Guidelines are accurately documented by the provider. SIU School of Medicine does not participate in the E-Verify program. Employment eligibility will be verified in accordance with applicable state and federal laws.

70% Coding

• Assign ICD-10 and CPT codes for services provided at the SIU Center for Family Medicine clinic.
• Through periodic audit reviews and utilizing the electronic health record, determine that chart documentation supports services indicated on the encounter form, and teaching physician supervision involvement requirements are met for resident services.
• Bring discrepancies to the attention of the physicians and other providers to resolve coding issues.
• Review charge tickets and encounter forms, and recommend needed changes.
• Teach residents appropriate coding practices, familiarity with inpatient and outpatient levels, and the requirements of the same.
• Review denied claims for coding errors, and corrects and/or provides the chart documentation for resubmittal for claims payment consideration.
• Keep abreast of Medicare and Medicaid regulations as they apply to the teaching physician guidelines.
• Code off-site services (Public Health Clinics, Nursing Home, Home Visit, etc.) by the Providers and ancillary personnel.
• Attend monthly Billing and Coding User Group meetings.

30% Billing/Posting

• Hospital Inpatient: This position works directly with faculty attendings to ensure Proper billing of hospital services. This requires a verification system to make sure that double billing does not occur, since the attending changes frequently. In addition, follow-up on deliveries and newborns is required to ensure services are billed.
• Periodically audit chart notes to determine that all appropriate charges were billed and notes are completed on a timely basis - report discrepancies to the Supervisor.
• Reviews, in detail, completed encounter forms and posts charges for the physician Services using a practice management system.
• Works TES edits to make sure adjustments are made to posted batches as required by Claims Manager claims scrubber.
• Reconciles discrepancies by processing end-of-day reports.
• Work and process the outstanding encounter report, bringing overdue charges to the attention of the Supervisor.
• Assist the Supervisor in completing the open encounter report.
• Assist the Supervisor in training residents, faculty, and nurses on the specialized FQHC billing and coding procedures.

Qualifications

• High school diploma or equivalent.
• Current certification as a 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), or current certification as a Certified Professional Coder (CPC) or a Certified Outpatient Coder (COC) by the American Academy of Professional Coders (AAPC) (formerly CPC-H certification).
• One (1) year/twelve (12) months of work experience comparable to that performed at the Reimbursement Coding Representative level of this series or in other positions of comparable responsibility.

About Southern Illinois University - School of Medicine: SIU School of Medicine was established in 1970 with a mission to educate physicians for central and southern Illinois. We are a medical school with four areas of excellence: medical education, patient care, research and community service. SIU School of Medicine provides education to undergraduate medical students, medical and surgical residents, fellows, and physician assistant students. Our clinical practice, SIU Medicine, includes a team of more than 250 health care professionals including university physicians and faculty members who are collectively dedicated to providing excellent medical care, advancement of care through research, and training the next generation of physicians. As the premier provider of health care services, SIU Medicine offers both primary care and specialized treatment services including preventative and diagnostic. SIU works in partnership with hospitals and clinics throughout central and southern Illinois to meet the health care needs of our communities.