BILLING SPECIALIST II

Posting Number: SRGV3876
Number of Vacancies: Multiple
Location: Harlingen, Texas
Department: School of Medicine / Clinical Affairs
FLSA: Non-Exempt

Scope of Job:
Reviews, determines accuracy of and applies the correct coding conventions to patient charge encounters, procedural and surgical services, as defined through physician documentation, regulatory agencies, and various third-party payers. To assist with the facilitation of the revenue cycle process following patient accounts through entire process from coding/charge entry to completion of payment process working within UT Health RGV EMR/Practice Management application and with contracted billing agency.

Description of Duties:
• Identifies and enters correct code selection from physician documentation, to include, but not be limited to: chart notes, abstracting from medical records documentation, medical diagnostic and/or interventional reports, ensuring compliant coding selections are reported.
• Enters most appropriate Reason for Visit, First Listed Primary Diagnosis, Procedure(s), Modifiers, and all Secondary Diagnosis accurately supports medical necessity and CCI edits.
• Verifies that the final diagnosis reflects the care and treatment rendered to the corresponding code entered.
• Works closely with Revenue Cycle team, clinics, physicians, departments, and contracted billing agency to resolve issues with insurance companies regarding incorrect registration information, claims processing, coding issues, and AR payments or denials.
• Responsible for accurate and timely processing/resolution of coding edits impacting submission of professional claims as well as payer rejections and/or denials.
• Identifies when a physician query is appropriate for further clarification. Recognizes when the documentation is missing or incomplete and routes appropriately. Validates Fee Schedule driven CPT code assignment and routes appropriately. Completes review and final coding when query and/or documentation is available.
• Ensure that patients are charged for all procedures. Reconciles charges against patient schedules.
• Verifies that coding guidelines are followed and ensures all elements of Evaluation & Management (E&M) level meet the Medicare guidelines for E&M level assignment.
• Informs providers of new coding conventions, changes in current coding conventions, and provides feedback on the providers’ coding practices.
• Maintains working day-to-day knowledge of electronic health record (EHR) and Practice Management (PM) system.
• Assists in evaluating the medical record for documentation consistency, adequacy, and signature requirements.
• Maintains Coding Quality Standards and Productivity Standard set by UT Health RGV.
• Identifies and documents new payer denial trends and notifies supervisor for escalated follow-up.
• Performs root cause analysis and identifies edit trends timely to minimize lag delays and maximize opportunities to improve processes.
• Communicates regularly and effectively with physicians, clinic staff, and revenue cycle staff for accurate and timely resolution of coding-related claim edits and appeals.
• Provides customer service to patients by addressing their questions, concerns or complaints.
• Responsible for posting payments and adjustments on patient accounts. Reconciles payment/adjustment batches daily.
• Runs billing, Accounts Receivable, denials, and any other Revenue Cycle reports as requested or needed.
• May assist clinics on completing their daily deposits information and ensure their deposit batches are reconciled daily.
• Assists in month end procedures and reporting.
• May assist in registering patient accounts where interfaces are not in place with UT Health partners. This includes entering demographic and insurance information, verifying insurance, entering referral information and/or prior authorization, posting charges and/or payments for clinic visits and/or hospital services.
• May assist clinics on figuring out patient responsibility based on Fee Schedule and/or assisting them in finding the correct CPT code to determine patient responsibility.
• Performs other duties as assigned.

Supervision Received:
General supervision from assigned supervisor.

Supervision Given:
Direct supervision of assigned staff.

Required Education:
• Associate Degree in Healthcare related field or Registered Health Information Technician certified, or
• Two (2) years of the required experience in lieu of associate degree in addition to the required experience.

Preferred Education:
None.

Licenses/Certifications:
Certified Professional Coder (CPC), Certified Professional Coder-Payer (CPC-P) or Certified Coding Specialist-Physician (CCP-P) from American Health Information Management Association (AHIMA) or American Academy Professional Coders (AAPC) will be required after 12 months of employment. Preferred: CPC, CPC-P, CCP-P or Certified Coding Specialist-Payer (CCS-P)

Required Experience:
Three (3) years of medical coding experience, knowledge of the entire claims billing, collections, and reimbursement processes experience in a multi-specialty practice, healthcare facility or ambulatory setting.

Preferred Experience:
Bilingual (English/Spanish).

Equipment:
Use of standard office equipment. Proficient use of computers and a working knowledge of Microsoft Office.

Working Conditions:
Needs to be able to successfully perform all required duties. Office Environment; some travel and weekend work is required.

Other:
Excellent verbal and written communication skills are required. Must be very familiar with CPT4, ICD10, HCPCs codes and use of modifiers. Ability to be flexible with assignments and multi-task as needed. Ability to demonstrate problem-solving skills in dealing with billing and collections related issues.

Physical Capabilities: N/A
Employment Category: Full-Time
Minimum Salary: Commensurate with Experience
Posted Salary: Commensurate with Experience
Position Available Date: 06/01/2019
Grant Funded Position: No
If Yes, Provide Grant Expiration Date:

EEO Statement:
UTRGV is an Affirmative Action/Equal Opportunity Employer that strives to hire without regard to race, color, national origin, sex, age, religion, disability, sexual orientation, gender identity or expression, genetic information or veteran status. UTRGV takes affirmative action to hire and advance women, minorities, protected veterans and individuals with disabilities.

Special Instructions to Applicants:
Dear Applicant,

Human Resources will not be held responsible for redacting any confidential information from the documents you attach with your application. The confidential information includes the following:

*Date of Birth
*Social Security Number
*Gender
*Ethnicity/Race

Please make sure that you omit this information prior to submission. We are advising that Human Resources will be forwarding your application to the department as per your submission.

If you have any questions, please do not hesitate to contact us at (956)665-8880 and/or careers@utrgv.edu.

Additional Information:
UTRGV is a distributed location institution and working location is subject to change based on need.

All UTRGV employees are required to have a criminal background check (CBC). Incomplete applications will not be considered.

Substitutions to the above requirements must have prior approval from the Chief Human Resources Officer.

To apply, visit https://careers.utrgv.edu/postings/20942





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