Claims Coding Specialists - Chapel Hill, NC

UNCPN Chapel Hill, NC

Positions perform complex duties in support of reimbursement from patients and insurance carriers for assigned clinical department. Substantial knowledge of all carrier policies, procedures and practices is required to collect carrier accounts receivable, reverse denials, and expedite coverage to the uninsured. Duties include reversing denials from carriers, recoding denied claims, and identifying coding trends. Work requires knowledge of coding but not to the extent of classes in the Medical Coder series.

1. Researches and determines if carrier denial of claim is valid and if not, abstracts information from medical records to support appeal of carrier denials. Makes changes to original coding of charges in accordance with ICD-9 and CPT codes.

2. Evaluates accounts, billing, payments, coding, and posting of accurate charges for a highly specialized and complex medical service such as transplant. Researches and resolves denied claims with carrier and patients.

3. Identifies coding trends that do not support maximum reimbursement. Makes recommendations that will prevent or correct identified coding errors.

4. Collaborates with internal staff and Clinical departments regarding filing, documentation and reimbursement issues. Works closely with clinic staff to modify documentation, filing processes, and encounter forms to enhance billing and collection process .

5. Serves as a resource for physicians, insurance carriers and patients to resolve questions/problems pertaining to patient accounts.

6. May serve as a lead worker to provide problem resolution and assistance to lower level positions.

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Job Qualifications:

Requires high school diploma and three years experience in a clerical, accounting or customer service setting including a minimum of six months work experience in CPT-4 and ICD-9 coding.