[Hiring] Coding and Reimbursement Specialist II @UnitedHealth Group

Role Description

Ensures accurate coding and reimbursement of claims submitted to third-party payors. Ability to perform analysis of patient account and review chart notes to validate accuracy of CPT, ICD10 & HCPCS codes. Ability to abstract information from the patient chart and update provider procedural and diagnosis coding as needed. Work with Accounts Receivable team to analyze denials, interpret medical policies and assist with preparation of appeals. Apply analytical skills to daily work to identify and improve processes. Perform in-depth research and review of denial trends with solutions to mitigate future claim rejections. Provide coding support to multiple departments within the Business Office. Able to communicate clearly with physicians and administrative staff. Attend seminars and maintain certification. Multi specialty coding experience is desired. Ability to analyze, audit and reconcile an account is critical to this position.

This position offers remote work for candidates based in Houston/ Pearland TX geographic area.

Primary Responsibilities

• Works assigned coding-related system and web-based work file(s)
• Conducts an analysis, immediately upon accessing accounts in assigned work files, to prevent missed filing or appeal deadlines. Appeal appropriately
• Conducts duties in accordance with industry federal and state billing and contractual obligations and in compliance with department policies and procedures
• Adjudicates claims in accordance with established coding guidelines and departmental policies and procedures
• Corrects physician coding as needed and refile corrected claims
• Researches denied claims to obtain necessary information from the appropriate payer’s website and reimbursement guidelines
• Meets established production and quality standards
• Identifies payer reimbursement patterns and trends and alerts and makes recommendations to management on an as needed basis
• Performs in-depth physician specialty rejection auditing and provides recommendations for charge rules, claim edits and Best Practice Alerts (BPA)
• Serves as a coding resource for CBO employees in order to assist with coding-related denials, appeals and timely responses to accounts needing additional attention
• Analyze and resolve aged accounts and provide feedback to the supervisor for auditing and training of junior follow-up representatives
• Maintains licensing by completing required annual CEU’s, and competency by staying abreast of payor(s) guidelines and policies regarding reimbursement and shares this information with department management on an as-needed basis
• Keeps abreast of changes in CPT and ICD-9/10 coding
• Serves as a resource to department staff on coding issues
• Attend seminars, and conferences to maintain AAPC coder certification
• Other duties as assigned

Qualifications

• Associates degree in Business Administration or related field may substitute for 2 years of experience
• Certified Professional Coder (CPC) or Certified Coding Specialist – Physician Based (CCS-P) Certified Coding Associate (CCA)
• 3+ years ICD 10 CPT, HCPCS coding/abstracting and healthcare billing and collections experience
• Diversified understanding of rules and regulations of Commercial Insurance and CMS guidelines
• Working knowledge of commercial insurance and CMS
• Knowledge of commercial payor policies, NCCI edits and EOB’s
• Understanding of EOB’s, strong PC skills
• Familiar with commercial payor websites & tools
• Presentation skills
• Excellent written and verbal communication skills

Preferred Qualifications

• 5+ years of experience in health care billing and collection
• Knowledge of secondary or supplemental insurance claim filing (COB)
• Experience with EPIC
• Able to retain composure, meet deadlines, and appropriately analyze, research, and resolve problems in a stressful environment with constant work-related interruptions
• Demonstrate dependability and an ability to work independently

Benefits

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 401k contribution (all benefits are subject to eligibility requirements)
• Hourly pay for this role will range from $20.00 - $36.00 per hour based on full-time employment