Coding and Reimbursement Specialist II: Kelsey-Seybold Clinic Pearland, TX

Explore opportunities with Kelsey-Seybold Clinic, part of the Optum family of businesses. Work with one of the nation's leading health care organizations and build your career at one of our 40+ locations throughout Houston. Be part of a team that is nationally recognized for delivering coordinated and accountable care. As a multi-specialty clinic, we offer care from more than 900 medical providers in 65 medical specialties. Take on a rewarding opportunity to help drive higher quality, higher patient satisfaction and lower total costs. Join us and discover the meaning behind Caring. Connecting. Growing together.

Describe purpose and function of position in no more than 4 sentences: 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 obtains 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

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required 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

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $20.00 - $36.00 per hour based on full-time employment. We comply with all minimum wage laws as applicable.

At UnitedHealth Group, our mission is to help people live healthier lives and help make the health system work better for everyone. Together, we are shaping the future of healthcare by harnessing technology and innovation to make care simpler to navigate, more affordable and more connected for the people we serve. We are committed to creating an inclusive workplace where everyone feels welcomed, valued, heard and respected, empowering people to bring their authentic selves to work and strengthening our collective impact through diverse talents, backgrounds, experiences and perspectives.

UnitedHealth Group and its affiliated brands are an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

UnitedHealth Group and its affiliated brands are a drug-free workplace. Candidates are required to pass a drug test before beginning employment.