• Claims Facility Coder

    Job Locations US-VA-Glen Allen
    Job ID
    2018-5146
  • About Us

    Don’t just find a job, find your WHY at a purpose-driven organization; discover a career at Virginia Premier.
    By blending quality benefits, affiliating with the world-renowned VCU Health System and offering career-advancing development programs, we allow our employees to focus on the meaningful work of improving and saving the lives of more than 200,000 people throughout the state of Virginia.
     
    At Virginia Premier, we are building an industry leading health care organization through dedicated teams that have heart, provide top-notch quality member services and embrace our mission of inspiring healthy living within the communities we serve. Our vision is to connect people to innovation, quality and affordable health care for all phases of life.
     
    If this sounds like you, read on!

    Overview

     

     The Claims Facility Coder is responsible for the internal auditing of UB04 claim accuracy according to the benefits structure, common billing practices and CMS and DMAS policies and procedures. This is to ensure the accurate adjudication of facility healthcare claims payment and/or denials. The Claims Facility Coder must be thoroughly familiar with UB04 claims processing/adjudication processes, reimbursement strategies, contract terms, benefit terms, Medicaid and Medicare rules and regulations, and standard operating procedures. The Claims Facility Coder is also responsible for communicating with internal and external customers on the outcome of the integrity of facility payments for the organization through verification of the accuracy of data-entered information. It is expected that the Claims Facility Coder is able to research and resolve issues, as well as make appropriate decisions as it relates to claims processing. The Claims Facility Coder must also be capable of developing a working relationship with regulatory agencies and third party vendors.

    Responsibilities

    • Must possess a high level of technical expertise in the claims application system, claims editing interfaces, facility reimbursement strategies (APR-DRG, SOI, OPEAPG, EAPG, Per Diem, Percent of Charge) and contract configurations
    • Review, Understand and Report any inconsistencies that are identified in regards to internal department policies and procedures to management
    • Work with the management staff to ensure all existing workloads have been addressed and are within acceptable time frames
    • Identify and track trends to promote process improvements and participate in the implementation of changes for continuous quality improvements
    • Use facility coding concepts and company policies and procedures to resolve a wide range of complex issues
    • Exercise judgement within defined procedures and practices to determine appropriate action
    • Attend both internal and external coding seminars and/or meetings
    • Perform other duties as assigned

    Qualifications

    MINIMUM EDUCATION REQUIREMENTS

    • High School diploma or GED required
    • Certified Inpatient Coder (CIC) and Certified Outpatient Coder (COC) required
    • Associates Degree in Business, Healthcare, or related field is preferred.

    SPECIAL KNOWLEDGE AND/OR SKILLS

    • In-depth knowledge of the health care environment and strong knowledge of UB04 claim forms
    • ICD-10-CM; ICD10-PCS, CPT, HCPCS Level II, Modifier Coding assignments
    • Strong attention to detail
    • Strong analytical and research skills
    • Strong verbal and written communication skills
    • Strong organizational skills
    • Intermediate competency in Microsoft Excel, Microsoft Word and Power Point.
    • Ability to work independently and effectively with others 

    WORK BACKGROUND/EXPERIENCE

    • Minimum 4 years’ claims processing or healthcare billing experience

    PHYSICAL REQUIREMENTS

    • Physical health sufficient to meet the ergonomic standards and demands of the position

     

    All qualified applicants will receive consideration for employment without regard to age, race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status. EOE

     

    Our mission is to inspire healthy living within the communities we serve!

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