NHRMC, established in 1967 in Wilmington, NC, is recognized as a preeminent healthcare organization focused on leading our community to outstanding health. We have an 855 bed network of hospitals and multi-specialty physician group practices with more than 200 physicians. With a network of primary, specialty, neighborhood clinics and regional medical centers; you will find our culture is the very definition of best in practice. Join us and find out how many ways NHRMC offers you the chance to focus on what really matters - our patients and community.
About the Job
Location: NHRMC Business Center A
Department: Coding - HIM
Full Time Equivalent: FTE: 1.000000
Work Type: 64 to 80 Hours Pay Period
Work Schedule: STD HRS - Standard-Exe or Office w flex
Exempt from Overtime: Exempt: No
What You'll Do
The Coding Reimbursement Specialist works independently but reports to the Coding and Clinical Abstracting Manager. This specialist is responsible for monitoring the appropriateness of the code assignments, including HIM assigned and chargemaster assigned codes, and reporting these findings to the Manager or designee. Serves as a contact for Patient Financial Services, responding to claim review requests pertaining to code assignment and following up as necessary. The specialist will make appropriate corrections to claims to resolve CCI and Medical Necessity edits to ensure appropriate charges and diagnosis are present on the final bill. This person will analyze the data from coding and/or charging errors and denials and in conjunction with the Coding Coordinator and Coding Auditors, under the direction of the Manager, to hold education sessions with coding staff, physicians, documentation specialists, billing staff, and ancillary department charge entry staff as needed to prevent future edits and denials. He/She maintains extensive knowledge of OPPS reimbursement, including ICD-10-CM, CPT HCPCS codes, UB-04 revenue codes, modifiers, billing regulations and coding guidelines. Remains current on all coding updates and changes, as well as payor specific requirements and regulations. Serves as a resource for information or clarification on CCI edits, LCDs and NCDs, and ethical coding and documentation standards, and regulatory requirements.
1. Identifies revenue cycle issues related to OPPS reimbursement, researches/analyzes data to recommend solutions.
2. Maintains timely turnaround of all assigned CCI and Medical Necessity edits.
3. Promptly processes all assigned edits, referrals, denials and appeals according to appropriate coding guidelines, billing rules, payor guidelines and regulations within timely filing targets.
4. Performs trend analyses to identify patterns and variations in coding practices and charge entry.
5. Communicates trends in departmental charging/coding issues to the Manager or department designee.
6. Maintains working knowledge of revenue cycle and aids in implementation of regulatory standards in compliance with correct coding guidelines.
7. Compares the coding and reimbursement profile of NHRMC with national and regional norms to identify variations requiring further investigation.
8. Serves as a contact person for billing staff to obtain necessary clarifications or concerns regarding CPT/HCPCS, UB-04 revenue coding, modifiers, billing regulations and coding guidelines CCI edits, LCDs/ NCDs, and ethical coding and documentation standards.
9. Maintains productivity and quality at or above standards with minimal supervision. Manages time effectively to permit completion of workload.
10. Analyzes payor regulations, including CCI edits, LCDs and NCDs, and the impact on reimbursement and coding guidelines and prepares tip sheets and reference material to share information with appropriate staff as directed.
11. Conducts educational programs with the Coding Coordinator and Coding Auditors, under the direction of the Coding Manager.
12. Serves as a resource for information and clarification on accurate and ethical coding and documentation standards, guidelines, and regulatory requirements.
13. Promotes public relations through prompt and courteous service.
14. Fosters respect for patient/staff privacy by maintaining confidentiality in all phases of work.
15. Codes all diagnosis, treatments, and procedures according to the appropriate classification system for that category of patient encounter, and in accordance with provisions of the Uniform Hospital Discharge Data Set as well as the interpretation of these provisions as issued by the American Hospital Association and American Health Information Management.
16. Abstracts patient information from records of all designated patient accounts as well as other designated patient types, and enters appropriate data elements into the computerized abstracting system.
* Cert Coding Specialist
* Reg Health Info Technologist
* Reg Records Administrator
* Cert Code Spec-Physician Based
* Certified Professional Coder
* Registered Nurse
* Licensed Practical Nurse
* Associate Degree
Experience: Three years’ relevant healthcare coding/ revenue cycle experience required. Extensive knowledge of ICD-10-CM, CPT/HCPCS, UB-04 revenue coding, modifiers, billing regulations and coding guidelines, CCI edits, LCDs/ NCDs, and ethical coding and documentation standards required. Five years’ experience in healthcare coding, claims auditing and denial processing, hospital based preferred. Combination of relevant education and/or experience considered. Demonstrates standards of performance (ownership, teamwork, communication, compassion) that support patient satisfaction and principles of service excellence.
Performs other duties as assigned.
Individual will possess commensurate combination of education, experience and qualifications.
This position description has been designed to indicate the general nature and level of work performed by employees within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities and qualifications which may be required of the employee assigned to the position. Depending on the location of the job, duties may vary. Receipt of the job description does not imply nor create a promise of employment, nor an employment contract of any kind; my employment with the Company is at will.
- Member Top 100 Hospitals – In 2016 NHRMC was recognized as a Top 100 Hospital demonstrating significant investment and financial sustainability for the communities we serve.
- Newsweek's 2020 list of Best Maternity Care Hospitals - NHRMC Betty H. Cameron Women's & Children's Hospital was named as a Best Maternity Care Hospital by Newsweek.
- Forbes America’s Best Large Employers 2018 and 2019- Link
- Becker’s 150 Top Places to Work in Healthcare- Link
- Healthgrades Outstanding Patient Experience
Consider a career at NHRMC and become part of this award winning team!