Reimbursement Coding Representative

Position Summary
The Reimbursement Coding Representative works with departments and staff within the Medical Billing Service to review routine claim denials. This may include contacting payers or staff by telephone, email or internet portal to correct CPT or ICD-10 codes and submitting appeals with the payer. Works under direct supervision from the Health Care Compliance Officer.

Duties & Responsibilities

Reviews and corrects, if necessary, ICD-10, HCPCS, and CPT codes of routine denied claims for resolution based on commercial insurance, CMS, and UICOMP guidelines. Applies a general knowledge of medical coding, in communication with providers, clinical and billing staff members via telephone or email to complete adjudication of denied claims or discrepancies in medical record documentation. Composes basic correspondence to third-party payers to resolve charge and billing problems via appeal process. The Reimbursement Representative will seek guidance from, or defer to, the Reimbursement Coding Specialists on complex issues. Reviews Epic coding work ques and corrects all errors delaying claim submission.

Confirms the transmission and acceptance of submitted claims in either the contracted clearinghouse or Epic. Corrects claim rejections in work queues to facilitate payment of open balances. Provides explanation of benefit decisions by third-party payers to patients and staff. Reviews Epic queues for charges that no payment or denial have been received. Works closely with billing department staff to resolve and authorize routine adjustments as needed. Determines if proper information is included in billing system to ensure claims are accurate. 

Attends training for certification maintenance and departmental needs.

Perform other duties and participate in special projects as assigned. Attends and participates in departmental staff meetings, coding meetings, or other meetings as requested.Attends training for certification maintenance and departmental needs.