Reimbursement specialist

Description

The primary purpose of this position is to assign ICD-10-CM, CPT, and HCPCS codes for inpatient and outpatient services by reviewing medical records documentation for those services provided by a physician or other qualified healthcare professionals.

Examples of Duties

Coding and Reimbursement - 90%

1) Review documentation and assign diagnosis and procedure codes for ancillary and other physician services using standardized coding systems such as ICD-10-CM, CPT, and HCPCS.

2) Review records for accuracy in the usage and / or assignment of modifiers for Evaluation and Management services along with any procedure modifiers as applicable.

3) Respond to requests from Patient Business Services for assistance in correction of claim information in regard to coding, dates of service, place of service, provider information, etc.

This assistance is also inclusive of writing appeal letters that would be submitted to insurance for reconsideration of a denied claim.

4) Provide expert advice and guidance to administrators, faculty, and staff as it relates to coding and documentation along with any third party payer regulations.

5) Assist other coding staff in the unit to provide coverage as needed and assist in training other coders when requested.

Miscellaneous - 10%

1) Other duties assigned.

Qualifications

• High school diploma or equivalent.
• Current certification as a Certified Coding Specialist (CCS) or Certified Coding SpecialistPhysician-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.

Supplemental Information

If you require assistance, please contact the Office of Human Resources at or call 217-545-0223 Monday through Friday, 8 : 00am-4 : 30pm.

The mission of Southern Illinois University School of Medicine is to optimize the health of the people of central and southern Illinois through education, patient care, research and service to the community.

This report is published in compliance with Federal Law titled the

Jeanne Clery Disclosure of Campus Security Policy and Crime Statistics Act."

Southern Illinois University School of Medicine is an Affirmative Action / Equal Opportunity employer who provides equal employment and educational opportunities for all qualified persons without regard to race, color, religion, sex, national origin, age, disability, sexual orientation, protected veteran status or marital status in accordance with local, state and federal law.

Pre-employment background screenings required.

Last updated : 2024-04-27