University Hospitals
Pro Fee Denials/Follow-Up Coder Remote
University Hospitals, Shaker Heights, Ohio, United States
Job Description – Pro Fee Denials/Follow‑Up Coder (Remote – 25000CTF)
A Brief Overview
Under the direction of the Revenue Cycle Supervisor – Coding, the Physician Coding Specialist II monitors and analyzes unresolved third‑party accounts for multi‑specialty group practices. This position initiates contact and negotiates appropriate resolutions to ensure timely payments of outstanding claims.
What You Will Do
Analyze, on a daily basis and in accordance with established time frames, outstanding insurance accounts and initiate appropriate and effective telephone and/or written follow‑up on the identified accounts.
Communicate with payors and other internal departments as required to obtain critical information that impacts the resolution of both current and future claims.
Research and respond to all telephone inquiries from the customer service department in a prompt, professional manner meeting departmental guidelines.
Review and correct coding edits and denials.
May code ICD‑10 from written documentation.
May abstract CPT/HCPCS codes.
May perform computer assisted coding functions.
Have working knowledge of coding rules and payer guidelines.
Consistently meet department productivity standards.
Consistently meet department quality standards.
Maintain patient/physician confidentiality at all times and effectively communicate and interact professionally with patients and physicians.
Provide appropriate information and feedback to various personnel within UHPS, support and utilize established departmental guidelines, and recommend additional research to other CBO departments.
Identify trends with insurance‑related issues and report findings to the Team Lead.
Act as a role model for professionalism through appropriate conduct and demeanor at all times.
Interpret written correspondence and either resolve the problem or forward it to another department for prompt resolution.
Communicate effectively utilizing the telephone, form letters or internal correspondence to resolve patient inquiries.
Handle multiple tasks simultaneously.
Have an understanding of insurance products and billing requirements to effectively resolve discrepancies in billing statements.
Perform other related duties as assigned.
Encounter Protected Health Information (PHI) as part of regular responsibilities. UH employees must abide by all requirements to safely and securely maintain PHI for our patients. Annual training, the UH Code of Conduct, and UH policies and procedures address appropriate use of PHI in the workplace.
Additional Responsibilities
Perform other duties as assigned.
Comply with all policies and standards.
For specific duties and responsibilities, refer to documentation provided by the department during orientation.
Must abide by all requirements to safely and securely maintain Protected Health Information (PHI) for our patients. Annual training, the UH Code of Conduct, and UH policies and procedures address appropriate use of PHI in the workplace.
Education
High School Equivalent / GED (Required)
Work Experience
2+ years of medical billing experience (Required)
Billing experience in a multi‑specialty group is a plus (Preferred)
Knowledge, Skills, & Abilities
Excellent interpersonal skills to work in partnership with others to influence and gain cooperation (Required proficiency)
Ability to recognize, evaluate, and solve problems (Required proficiency)
Strong verbal and written communication skills (Required proficiency)
Extensive knowledge of the claims development process and third‑party insurance program requirements (Required proficiency)
Must possess basic knowledge of ICD‑9 and CPT coding (Required proficiency)
Ability to handle a variety of tasks with speed, attention to detail, and accuracy (Required proficiency)
Computer literate, experience with basic software packages.
Licenses and Certifications
Certified Professional Coder (CPC) CPC‑A, CPC‑H, or CPC‑P (Required) or
Certified Coding Specialist (CCS) or CCS‑P (Required) or
Registered Health Information Technologist (RHIT) (Required) or
Registered Health Information Administrator (RHIA) (Required)
RCC (Preferred) or
ROCC (Preferred)
Physical Demands
Standing Occasionally
Walking Occasionally
Sitting Constantly
Lifting Rarely up to 20 lbs
Carrying Rarely up to 20 lbs
Pushing Rarely up to 20 lbs
Pulling Rarely up to 20 lbs
Climbing Rarely up to 20 lbs
Balancing Rarely
Stooping Rarely
Kneeling Rarely
Crouching Rarely
Crawling Rarely
Reaching Rarely
Handling Occasionally
Grasping Occasionally
Feeling Rarely
Talking Constantly
Hearing Constantly
Repetitive Motions Frequently
Eye/Hand/Foot Coordination Frequently
Travel Requirements
10%
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Under the direction of the Revenue Cycle Supervisor – Coding, the Physician Coding Specialist II monitors and analyzes unresolved third‑party accounts for multi‑specialty group practices. This position initiates contact and negotiates appropriate resolutions to ensure timely payments of outstanding claims.
What You Will Do
Analyze, on a daily basis and in accordance with established time frames, outstanding insurance accounts and initiate appropriate and effective telephone and/or written follow‑up on the identified accounts.
Communicate with payors and other internal departments as required to obtain critical information that impacts the resolution of both current and future claims.
Research and respond to all telephone inquiries from the customer service department in a prompt, professional manner meeting departmental guidelines.
Review and correct coding edits and denials.
May code ICD‑10 from written documentation.
May abstract CPT/HCPCS codes.
May perform computer assisted coding functions.
Have working knowledge of coding rules and payer guidelines.
Consistently meet department productivity standards.
Consistently meet department quality standards.
Maintain patient/physician confidentiality at all times and effectively communicate and interact professionally with patients and physicians.
Provide appropriate information and feedback to various personnel within UHPS, support and utilize established departmental guidelines, and recommend additional research to other CBO departments.
Identify trends with insurance‑related issues and report findings to the Team Lead.
Act as a role model for professionalism through appropriate conduct and demeanor at all times.
Interpret written correspondence and either resolve the problem or forward it to another department for prompt resolution.
Communicate effectively utilizing the telephone, form letters or internal correspondence to resolve patient inquiries.
Handle multiple tasks simultaneously.
Have an understanding of insurance products and billing requirements to effectively resolve discrepancies in billing statements.
Perform other related duties as assigned.
Encounter Protected Health Information (PHI) as part of regular responsibilities. UH employees must abide by all requirements to safely and securely maintain PHI for our patients. Annual training, the UH Code of Conduct, and UH policies and procedures address appropriate use of PHI in the workplace.
Additional Responsibilities
Perform other duties as assigned.
Comply with all policies and standards.
For specific duties and responsibilities, refer to documentation provided by the department during orientation.
Must abide by all requirements to safely and securely maintain Protected Health Information (PHI) for our patients. Annual training, the UH Code of Conduct, and UH policies and procedures address appropriate use of PHI in the workplace.
Education
High School Equivalent / GED (Required)
Work Experience
2+ years of medical billing experience (Required)
Billing experience in a multi‑specialty group is a plus (Preferred)
Knowledge, Skills, & Abilities
Excellent interpersonal skills to work in partnership with others to influence and gain cooperation (Required proficiency)
Ability to recognize, evaluate, and solve problems (Required proficiency)
Strong verbal and written communication skills (Required proficiency)
Extensive knowledge of the claims development process and third‑party insurance program requirements (Required proficiency)
Must possess basic knowledge of ICD‑9 and CPT coding (Required proficiency)
Ability to handle a variety of tasks with speed, attention to detail, and accuracy (Required proficiency)
Computer literate, experience with basic software packages.
Licenses and Certifications
Certified Professional Coder (CPC) CPC‑A, CPC‑H, or CPC‑P (Required) or
Certified Coding Specialist (CCS) or CCS‑P (Required) or
Registered Health Information Technologist (RHIT) (Required) or
Registered Health Information Administrator (RHIA) (Required)
RCC (Preferred) or
ROCC (Preferred)
Physical Demands
Standing Occasionally
Walking Occasionally
Sitting Constantly
Lifting Rarely up to 20 lbs
Carrying Rarely up to 20 lbs
Pushing Rarely up to 20 lbs
Pulling Rarely up to 20 lbs
Climbing Rarely up to 20 lbs
Balancing Rarely
Stooping Rarely
Kneeling Rarely
Crouching Rarely
Crawling Rarely
Reaching Rarely
Handling Occasionally
Grasping Occasionally
Feeling Rarely
Talking Constantly
Hearing Constantly
Repetitive Motions Frequently
Eye/Hand/Foot Coordination Frequently
Travel Requirements
10%
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