Reimbursement/Coding Specialist

Overview

USA Health is Transforming Medicine along the Gulf Coast to care for the unique needs of our community. 

USA Health is changing how medical care, education and research impact the health of people who live in Mobile and the surrounding area. Our team of doctors, advanced care providers, nurses, therapists and researchers provide the region's most advanced medicine at multiple facilities, campuses, clinics and classrooms. We offer patients convenient access to innovative treatments and advancements that improve the health and overall wellbeing of our community.

Responsibilities

Assists in coordinating and maintaining the professional reimbursement program for USA Health to ensure compliance with current payments, rules, and legislative regulations that impact the physician’s billing and collections process; monitors and ensures compliance with Medicare and Medicaid documentation guidelines for USA Health; monitors and evaluates current reimbursement/payment rules and ensures legislative and regulatory changes are implemented appropriately for USA Health; communicates to the clinical faculty, staff and departmental billing personnel changes impacting billing; assists physicians in determining appropriate use of codes for maximizing reimbursement of physician’s service; develops techniques for effective analyses of billing collection efforts; ensures compliance with Medicare and insurance carriers guidelines related to documentation, coding and medical necessity; analyzes and develops systems related to billing, collecting and reporting of professional and medical services to ensure recovery of all professional and technical oncology charges; trains new personnel in appropriate charge capture and charge entry; provides reimbursement patterns and trend analyses to manager and physicians; provides on-going in-service training for billing personnel as well as clinical faculty including training of new physician in coding (CPT, ICD9-CM); assists in resolving third party denials received by Billing and Collection Department and assists with reimbursement appeals and problems; prepares reports and analyzes to include financial reports, setting forth progress, adverse trends and appropriate recommendations or conclusions; participates in meetings with subordinates to ensure compliance with established practices, to new polices and to keep employees aware of changes and current standards; develops physician billing forms and examination forms for physician use; regular and prompt attendance; ability to work schedule as defined and additional hours as required; related duties as required.

Qualifications

High school diploma or equivalent, four years of medical coding experience, and certification as a Certified Professional Coder.