Reimbursement Coding Specialist (U) (Hybrid/PRN) (Decatur)

Department: Family and Community Medicine/Decatur-SMS
Division: NA
Location: Decatur
Job Category: Office Support

Overview:
The primary purpose of this position is to be respsonsible for ICD-10 and CPT coding of services provided by physicians and mid-level providers for all outpatient and inpatient services for Decatur 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 to ensure that theTeaching Physician Guidelines are accurately documented by the provider.

Salary: $20.45/hour

Hours: As needed
SIU School of Medicine
CIVIL SERVICE POSITION DESCRIPTION

INCUMBENT CSN: _____________FLSA STATUS Exempt

PRESENT CLASSIFICATION Reimbursement Coding Specialist DATE October 2023

DEPARTMENT/DIVISION SIU Center for Family Medicine/ FQHC Coding and Billing Unit

FUNCTION

The primary purpose of this position is to be respsonsible for ICD-10 and CPT coding of
services provided by physicians and mid-level providers for all outpatient and inpatient services
for Decatur 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 to ensure that theTeaching Physician Guidelines are accurately documented by the
provider.

ORGANIZATIONAL RELATIONSHIPS

This position reports to the Reimbursement Coding Coordinator who reports to the Director of
Finance who in turn reports to the Executive Director of the SIU Center for Family Medicine.

DUTIES AND RESPONSIBILITIES

The following information is intended to be representative of the work performed by incumbent
in this position and is not all-inclusive. The omission of a specific duty or responsibility will not
preclude it from the position if the work is similar, related, or a logical extension of position
responsibilities.

Demonstrates, by actions, commitment to the mission and the behavioral standards of SIU
School of Medicine. Provides excellent service to both internal and external customers through
collaboration and partnership; compassion and respect; integrity and accountability; diversity
and inclusion; as well as continuous learning and improvement.

70% Coding

1. Assign ICD-10 and CPT codes for services provided at the Decatur SIU Center for
Family Medicine clinic.

2. Through periodic audit reviews and utilizing the electronic health record, determine that
chart documentation supports services indicated on encounter form, and teaching
physician supervision involvement requirements are met for resident services.

3. Bring discrepancies to the attention of the physicians and other providers to resolve
coding issues.

4. Perform review on charge tickets and encounter forms and recommends needed
changes.

5. Teach residents appropriate coding practices, familiarity with inpatient and outpatient
levels and the requirements of same.

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6. Review denied claims for coding errors, and corrects and/or provides chart
documentation for re-submittal for claims payment consideration.

7. Keep abreast of Medicare and Medicard regulations as they apply to the teaching
physician guidelines.

8. Code off-site services (Public Hlth Clinics, Nursing Home, Home Visit, etc.) by the
Providers and ancillary personnel.

9. Attend monthly Billing and Coding User Group meetings.

30% Billing/Posting
.

10. 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.

11. Periodically audit chart notes to determine all appropriate charges were billed and
notes are completed on a timely basis – report discrepancies to the Supervisor.

12. Reviews, in detail, completed encounter forms and posts charges for physician
Services using practice management system.

13. Works TES edits to make sure adjustments are made to posted batches as required by
Claims Manager claims scrubber.

14. Reconciles discrepancies by processing end of day reports.

15. Work and process the outstanding encounter report, bringing overdue charges to the
attention of the Supervisor.

16. Assist the Supervisor in completing the open encounter report.

17. Assist the Supervisor in training residents, faculty and nurses on the specialized FQHC
billing and coding procedures.

SKILLS AND ABILITIES NEED FOR THE POSITION

Sensitive to the needs of underrepresented minority populations

RESPONSIBILITY

A. Supervisory Controls – The supervisor, as needed, assigns duties. The employee
establishes the procedures with the assistance and approval of the supervisor. The

employee will then be expected to work independently, except for occasional consultation
with the supervisor.

Page 3 – Reimbursement Coding Specialist

B. Guidelines – The individual in this position must follow the requirements of the industry
standards for Medicare, Medicaid, ICD-10, CPT-4, and the coding procedures for teaching
institutions dictated by government regulations.

DIFFICULTY

A. Complexity – Must be knowledgeable regarding government regulations for coding and
billing.

B. Scope and Effect – The individual in this position has a financial impact on services
provided at the Center and outside the Center. It is extremely important to resident training
and education.

PERSONAL CONTACTS

The individual in this position will have frequent contact with all faculty, residents and staff, as
well as contact with individuals in the P&S Patient Business Office and other offices outside the
Center.

ENVIRONMENTAL, HEALTH AND SAFETY RESPONSIBILITIES

Participates in meetings, trainings, and other environmental, health and safety activities as
required by SIU School of Medicine.

WORKING CONDITIONS

See attached Physical and Environmental Requirements form.

UNIT SIGNATURES:
INCUMBENT: __________________________________ DATE: ___________________

REVIEWED BY: _________________________________ DATE: ___________________
Jennilee Dunn, Supervisor

_________________________________ DATE: ___________________
Stefanie Garman, Deputy Director of FQHC Coding and Billing

ADMINISTRATIVE APPROVAL:
___________________________________ DATE: ___________________
Iris Wesley, Executive Director