Coding Reimbursement Coordinator

Join the Cleveland Clinic team, where you will work alongside passionate caregivers and provide patient-first healthcare. Cleveland Clinic is recognized as one of the top hospitals in the nation. At Cleveland Clinic, you will work alongside passionate and dedicated caregivers, receive endless support and appreciation, and build a rewarding career with one of the most respected healthcare organizations in the world.

As a Coding Reimbursement Coordinator, you will:

• Research and resolve claim denials, pre-bill edits, and pre-bill errors.

• Provide reimbursement education to Coders, Quality Education Coordinators (QEC) and others regarding billing requirements for outpatient coded data.

• Provide one-on-one education and act as a coding reimbursement resource.

• Conduct and help facilitate a review of failed claims pre- and post-billing.

• Provide information on denial trends to coding supervisors and contribute to process improvement.

The ideal future caregiver is someone who:

• Has a background in working denials and is familiar with payer portals.

• Has the ability to work any type of specialty or coding denial, including Surgical and E/M coding.

• Is able to work independently.

• Demonstrates a strong work ethic.

This position is work from home with flexible scheduling.

At Cleveland Clinic, we know what matters most. That's why we treat our caregivers as if they are our own family, and we are always creating ways to be there for you. Here, you'll find that we offer: resources to learn and grow, a fulfilling career for everyone, and comprehensive benefits that invest in your health, your physical and mental well-being and your future. When you join Cleveland Clinic, you'll be part of a supportive caregiver family that will be united in shared values and purpose to fulfill our promise of being the best place to receive care and the best place to work in healthcare.

Responsibilities:

• Researches and resolves claim denials, pre-bill edits, and pre-bill errors.

• Provides feedback to the coding management team and staff regarding denial type errors.

• Applies LCD and NCD (local and national coverage determination) rules.

• Develops and maintains outpatient reimbursement manuals to support quality coding on the Coding SharePoint site.

• Assists with and/or provides suggestions for continuing education topics and issues for coding staff.

• Educates groups and individuals within HIM regarding coding denials, modifier assignments, and the reimbursement process. When appropriate, assists in developing and maintaining CCHS facilities' coding guidelines in accordance with Official Coding Guidelines.

• Acts as a liaison among all department managers, staff, physicians and administration with respect to denials issues.

• Assists with the development of denial reports and other statistical reports.

• Works with department supervisors, managers, and physician offices.

• Supports coding program initiatives, promotes good morale and cooperation.

• Encourages others and values their input.

• Shares information and seeks ways to add value both to the customer and to the team.

• Anticipates and responds to changing skills requirements.

• Seeks opportunities to learn new skills.

• Actively coaches and encourages team members to do the same.

• Complies with CCHS and departmental policies and procedures consistently.

• Other duties as assigned.

Education:

• High School Diploma is required.

Certifications:

• Depending on department needs the Certified Professional Coder (CPC) through the American Academy of Professional Coders (AAPC), Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT) or Certified Coding Specialist (CCS) through the American Health Information Management Association (AHIMA) is required and must be maintained.

Complexity of Work:

• Coding assessment relevant to the work may be required.

• Requires critical thinking skills, decisive judgment and the ability to work with minimal supervision.

• Must be able to work in a stressful environment and take appropriate action.

Work Experience:

• A minimum of two years of experience in a clinical environment involving the accurate interpretation and coding/abstraction of therapeutic/diagnostic measures and procedures of a diverse patient population.

• In-depth knowledge of ICD-10-CM coding principles, APC assignment, and modifier assignment.

• Formal coursework in anatomy, physiology and medical terminology in order to accurately interpret the medical record.

• Working knowledge of both personal computer applications and mainframe computer systems.

• Excellent verbal and written communications.

• Must be detail oriented and analytical in nature.

• A Bachelor's Degree in Health Information Management may be substituted for up to one year of required experience.

Physical Requirements:

• Ability to perform work in a stationary position for extended periods.

• Ability to travel throughout the hospital system.

• Ability to work with physical records, such as retrieving and filing them.

• Ability to operate a computer and other office equipment.

• Ability to communicate and exchange accurate information.

• In some locations, ability to move up to 25 lbs.

Personal Protective Equipment:

• Follows standard precautions using personal protective equipment as required.

Pay Range

Minimum hourly: $27.65

Maximum hourly: $42.17

The pay range displayed on this job posting reflects the anticipated range for new hires. While the pay range is displayed as an hourly rate, Cleveland Clinic recruiters will clarify whether the compensation is hourly or salary. A successful candidate's actual compensation will be determined after taking factors into consideration such as the candidate's work history, experience, skill set, and education. This is not inclusive of the value of Cleveland Clinic's benefits package, which includes among other benefits, healthcare/dental/vision and retirement.