Claims Examiner, Sr. jobs in Billings, MT

This position is eligible for full-time remote and/or telework if located in Montana, Wyoming, Hawaii, Kansas, Minnesota, Michigan, Arizona, or Texas.

This position may be eligible for a sign-on bonus, tuition loan repayment, and relocation assistance

Responsible for researching and analyzing coding related pre-bill scrubber edits , denials, and requests for review from Patient Financial services , and ensuring proper coding in compliance with government and third party payer regulations and CPT-4 , ICD, and HCPCs guidelines. Responsible to appeal denials and follow up with payers until the denied claims are paid. Collaborates with multiple departments and participates in review of Recovery Audit Contractor and other government audits and appeals. Provides reports to CBO contacts for trending and research and clarification of coding (ICD, CPT-4/HCPCS) and abstracting of diseases and surgical procedures. Provides education to the CBO teams based on findings .Ensures adherence to all applicable Billings Clinic Central Business Office and regulatory compliance policies and procedures governing medical records coding, insurance billing and reimbursement methodologies

Essential Job Functions

• Supports and models behaviors consistent with Billings Clinic’s mission, vision, values, code of business conduct and service expectations. Meets all mandatory organizational and departmental requirements. Maintains competency in all organizational, departmental and outside agency standards as it relates to the environment, employee, patient safety or job performance.
• Performs all other duties as assigned or as needed to meet the needs of the department/organization.
• Researches, analyzes, and appeals government and third party payer coding related denials of service based on explanation of benefits and remittance advice information and/or patient requests. Identifies trends/patterns that could pose a compliance risk or reimbursement issue and reports them to CBO Coding Management and CBO Coding Advisor for coding and documentation education, trending, and monitoring.
• Researches, analyzes, and resolves government and third party payer coding related per-bill scrubber edits.
• Identifies and reports any regulatory or compliance concerns to Coding Resources Manager.
• Monitors coding related audit activity in the organization’s tracking tool. Works in conjunction with the Clinical Coding Specialist and Coding Advisors to review of all coding related external audits determinations. Apply clinical and coding assessment skills to medical record, and extract supportive documentation for appeals. Report any issues to the department managers and compliance team. Provide clinical documentation education to appropriate staff and physicians. Communicate with outside agencies when necessary to clarify issues.
• Identifies needs and sets goals for own growth and development; meets all mandatory organizational and departmental requirements

Minimum Qualifications

Education

• High School or GED

Experience

• Minimum Two years experience in a multi-specialty clinic and/or hospital working with ICD-CM, CPT-4, HCPCS, DRG coding
• Previous demonstrated experience in a clinical setting performing technical responsibilities related to ICD-CM, CPT-4/HCPCS, DRG coding, fees and reimbursement
• Demonstrated ability to understand and develop information using databases and creating complex spreadsheets. Intermediate knowledge of Microsoft Office products, including Word, Excel and PowerPoint.
• Prior training in anatomy, medical terminology and coding
• Or an equivalent combination of education and experience relating to the above tasks, knowledge, skills and abilities will be considered

Certifications and Licenses

• Registered Health Information Technician (RHIT) or Registered Health Information Administrator (RHIA), Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) or other AHIMA or AAPC recognized credentials required.