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Reimbursement Specialist-SL ENT

Company: St Lukes Hospital
Location: Duluth
Posted on: January 15, 2022

Job Description:

JOB SUMMARY The Reimbursement Specialist, under the direction of the Clinic Manager, is responsible for specialty service and Outpatient Surgery Center coding and for coordinating procedures resulting in timely coding and charge capture for all services provided in the Clinic. Functions as a Clinic coding resource and assists in physician and staff education related to coding, documentation, and chart audits. Provides support to Clinic business office staff. MINIMUM QUALIFICATIONS Education: Associates Degree in Health Information (Medical Record) Technology or Billing and Coding and (see Experience) OR (see Experience). Experience:#One (1) year successful work experience in a medical coding position; or a combination of four (4) years of education and experience in a medical coding position. ICD10-CM and CPT/HCPCS coding experience. Licensure/Certification/Registration: N/A PREFERRED QUALIFICATIONS Education: N/A Experience: Surgical Specialty coding experience. Licensure/Certification/Registration: Registration as a health information technician or coding certification (CCS, CCS-P, CPC, or CPC-H). KNOWLEDGE, SKILLS AND ABILITIES Knowledge of physician office diagnosis and procedure coding (ICD-9-CM, CPT, HCPCS). Knowledge of medical office billing procedures including Medicare compliance, insurance verification and private pay arrangements. Knowledge of anatomy and physiology and medical terminology. Knowledge of medical record documentation principles that support physician office visit coding. Knowledge of personal computing applications and skill in computer keyboarding. Knowledge of adult education principles. Numerical aptitude and ability to perform accurate, detailed work. Ability to effectively communicate with patients, physicians, client company representatives, attorneys, support staff, and administration. Ability to understand and follow complex oral and written instructions and explain complex medical terms and insurance requirements in easily understood terms. Ability to prioritize and complete tasks in an independent manner. Ability to demonstrate good judgment and accept personal responsibility. Ability to present a professional image. Ability to initiate appropriate action to resolve insurance claim rejections. Ability to maintain patient and client confidentiality. Ability to write legibly, see, hear, read, and speak English. # READING - Intermediate: Ability to read and interpret documents such as operating and maintenance instructions and procedure manuals. WRITING - Intermediate: Ability to write routine reports, correspondence, or procedures. SPEAKING - Intermediate: Ability to effectively present information in one-on-one, small group situations or before groups of customers, clients, and other employees of the organization. MATHEMATICAL SKILLS - Basic Skills: Ability to add and subtract two-digit numbers and to multiply and divide with 10#s and 100#s. Ability to perform these operations using units of American money and weight measurement, volume, and distance. REASONING ABILITY - Intermediate Skills: Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form. Ability to deal with problems involving several concrete variables in standardized situations. PHYSICAL DEMANDS AND ENVIRONMENT PHYSICAL DEMANDS Prolonged, extensive, considerable sitting, walking and bending. Considerable reaching, stopping, kneeling and crouching and lifts objects up to twenty-five (25) pounds in weight. # Stand - Occasionally Under 1/3 (1-2.5 hours) Walk - Occasionally Under 1/3 (1-2.5 hours) Sit - Continuously Over 2/3 (5.5 # 8 hours) Use hands to finger, handle, or feel - Continuously Over 2/3 (5.5 # 8 hours) Reach with hands and arms - Occasionally Under 1/3 (1-2.5 hours) Stoop, squat, kneel, or#crouch - Occasionally Under 1/3 (1-2.5 hours) Bending-repetitive forward - Occasionally Under 1/3 (1-2.5 hours) Talk or hear - Continuously Over 2/3 (5.5 # 8 hours) # LIFTING REQUIREMENTS Up to 10 pounds - Frequently 1/3 to 2/3 (2.5 # 5.5 hours) Up to 25 pounds - Occasionally Under 1/3 (1-2.5 hours) # WORK ENVIRONMENT Typical Noise Level - Moderate noise (examples: business office with computers and printers, light traffic) # WORKING CONDITIONS Works in a normal clinic business office environment


  • JOB SUMMARY

  • The Reimbursement Specialist, under the direction of the Clinic Manager, is responsible for specialty service and Outpatient Surgery Center coding and for coordinating procedures resulting in timely coding and charge capture for all services provided in the Clinic. Functions as a Clinic coding resource and assists in physician and staff education related to coding, documentation, and chart audits. Provides support to Clinic business office staff.

  • MINIMUM QUALIFICATIONS

  • Education: Associates Degree in Health Information (Medical Record) Technology or Billing and Coding and (see Experience) OR (see Experience).


  • Experience: One (1) year successful work experience in a medical coding position; or a combination of four (4) years of education and experience in a medical coding position. ICD10-CM and CPT/HCPCS coding experience.


  • Licensure/Certification/Registration: N/A

  • PREFERRED QUALIFICATIONS

  • Education: N/A


  • Experience: Surgical Specialty coding experience.


  • Licensure/Certification/Registration: Registration as a health information technician or coding certification (CCS, CCS-P, CPC, or CPC-H).

  • KNOWLEDGE, SKILLS AND ABILITIES
  • Knowledge of physician office diagnosis and procedure coding (ICD-9-CM, CPT, HCPCS). Knowledge of medical office billing procedures including Medicare compliance, insurance verification and private pay arrangements. Knowledge of anatomy and physiology and medical terminology. Knowledge of medical record documentation principles that support physician office visit coding. Knowledge of personal computing applications and skill in computer keyboarding. Knowledge of adult education principles. Numerical aptitude and ability to perform accurate, detailed work. Ability to effectively communicate with patients, physicians, client company representatives, attorneys, support staff, and administration. Ability to understand and follow complex oral and written instructions and explain complex medical terms and insurance requirements in easily understood terms. Ability to prioritize and complete tasks in an independent manner. Ability to demonstrate good judgment and accept personal responsibility. Ability to present a professional image. Ability to initiate appropriate action to resolve insurance claim rejections. Ability to maintain patient and client confidentiality. Ability to write legibly, see, hear, read, and speak English.



  • READING - Intermediate: Ability to read and interpret documents such as operating and maintenance instructions and procedure manuals.


  • WRITING - Intermediate: Ability to write routine reports, correspondence, or procedures.


  • SPEAKING - Intermediate: Ability to effectively present information in one-on-one, small group situations or before groups of customers, clients, and other employees of the organization.


  • MATHEMATICAL SKILLS - Basic Skills: Ability to add and subtract two-digit numbers and to multiply and divide with 10's and 100's. Ability to perform these operations using units of American money and weight measurement, volume, and distance.


  • REASONING ABILITY - Intermediate Skills: Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form. Ability to deal with problems involving several concrete variables in standardized situations.

  • PHYSICAL DEMANDS AND ENVIRONMENT
  • PHYSICAL DEMANDS
  • Prolonged, extensive, considerable sitting, walking and bending. Considerable reaching, stopping, kneeling and crouching and lifts objects up to twenty-five (25) pounds in weight.



  • Stand - Occasionally Under 1/3 (1-2.5 hours)


  • Walk - Occasionally Under 1/3 (1-2.5 hours)


  • Sit - Continuously Over 2/3 (5.5 - 8 hours)


  • Use hands to finger, handle, or feel - Continuously Over 2/3 (5.5 - 8 hours)


  • Reach with hands and arms - Occasionally Under 1/3 (1-2.5 hours)


  • Stoop, squat, kneel, or crouch - Occasionally Under 1/3 (1-2.5 hours)


  • Bending-repetitive forward - Occasionally Under 1/3 (1-2.5 hours)


  • Talk or hear - Continuously Over 2/3 (5.5 - 8 hours)

  • LIFTING REQUIREMENTS

  • Up to 10 pounds - Frequently 1/3 to 2/3 (2.5 - 5.5 hours)


  • Up to 25 pounds - Occasionally Under 1/3 (1-2.5 hours)

  • WORK ENVIRONMENT
  • Typical Noise Level - Moderate noise (examples: business office with computers and printers, light traffic)


  • WORKING CONDITIONS
  • Works in a normal clinic business office environment

Keywords: St Lukes Hospital, Duluth , Reimbursement Specialist-SL ENT, Other , Duluth, Minnesota

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