Reimbursement Coding Specialist - UI Health Compliance

Reimbursement Coding Specialist - UI Health Compliance

Hiring Department: UI Health Compliance

Hiring Unit: University of Illinois Hospital & Health Sciences System (UI Health)

Location: Chicago, IL USA

Requisition ID: 1022890

Posting Close Date: 4/8/2024

Position Number: CE9465

About the University of Illinois Hospital & Health Sciences System (UI Health)

The University of Illinois Hospital & Health Sciences System (UI Health) provides comprehensive care, education, and research to the people of Illinois and beyond. A part of the University of Illinois at Chicago (UIC), UI Health comprises a clinical enterprise that includes a 495-bed tertiary care hospital, 22 outpatient clinics, and 13 Mile Square Health Center facilities, which are Federally Qualified Health Centers. It also includes the seven UIC health science colleges: the College of Applied Health Sciences; the College of Dentistry; the School of Public Health; the Jane Addams College of Social Work; and the Colleges of Medicine, Pharmacy, and Nursing, including regional campuses in Peoria, Quad Cities, Rockford, Springfield, and Urbana. UI Health is dedicated to the pursuit of health equity.

This is a full-time and benefits eligible position. Hybrid and flexible work schedules are available. UI Health offers competitive salaries commensurate with experience. In addition all full time benefits eligible positions include a comprehensive benefits package which include; Health, Dental, Vision, Life, Disability & AD&D insurance, a defined benefit pension plan as well as paid leave which includes; Vacation, Holiday and Sick. In addition we offer tuition waivers for employees and dependents. Click for a complete list of Employee Benefits

UI Health is seeking a Reimbursement Coding Specialist to join our UI Health Compliance team. This role serves as an organizational resource on matters relating to hospital coding, billing, and reimbursement matters. Responsible for performing compliance auditing, monitoring, and reviews of various hospital-based services in accordance with the compliance annual plan or as needed. Partners with operational areas in addressing identified deficiencies. Coordinates process improvement activities and recommends necessary controls to prevent non-compliance.

Duties & Responsibilities:

• Assists the Director of Reimbursement Compliance in developing and maintaining an annual compliance audit plan and audit workflow

• Researches all relevant regulations, policies, procedures, and other standards such as coding guidelines, CMS policies and other sources for audits as necessary and prepares summary of findings

• Performs billing and coding reviews on claims to determine compliance with billing, coding, or other payment guidelines

• Documents audit results and communicates them as directed by the Director of Reimbursement Compliance; provides an analysis of findings and recommendations with each report

• Provide education to the organization as needed based on the results of audits and reviews

• Assists in developing workflows, claim edits, or other mechanisms to ensure proper billing and coding

• Serves as an organizational resource on matters relating to hospital coding, and billing

• Monitors existing and emerging compliance billing and coding issues and trends for any needed remediation

• Assist the Director of Reimbursement Compliance in evaluating the adequacy and effectiveness of internal controls for compliance with the requirements of Federal healthcare programs

• Prepares summaries and reports for the Compliance Department, hospital departments, compliance committees, and other appropriate groups regarding the results of the reviews and the status of corrective action plans

• Performs special projects, or process improvement initiatives based on identified risk areas or targeted audits (e.g., OIG work plan, RAC reviews, or research billing).

• Assists operational leadership with questions regarding billing and coding compliance and provides analysis and recommendations as necessary

• Maintains professional competency through continuing professional education and staying abreast of regulatory changes

Minimum Qualifications Required:

• High school diploma or equivalent.

• Current certification as a Certified Coding Specialist (CCS) or Certified Coding Specialist-Physician-based (CCS-P) or Registered Health Information Technician (RHIT) or Registered Health Information Administrator (RHIA) by the American Health Information Management Association (AHIMA), or current certification as a Certified Professional Coder (CPC) or a Certified Outpatient Coder (COC) by the American Academy of Professional Coders (AAPC) (formerly CPC-H certification).

• One (1) year/twelve (12) months of work experience comparable to that performed at the Reimbursement Coding Representative level of this series or in other positions of comparable responsibility.

Preferred Qualifications:

• Prior experience in healthcare reimbursement compliance matters in an academic medical center

• Prior EPIC experience

• Compliance audit or internal audit experience

• Billing and Coding certification with 5 years of hospital billing and coding experience

• Possess a demonstrated knowledge of clinical processes, clinical coding, revenue codes, status indicators, charge processes, and audits

• Licenses/Certifications: Certified Inpatient Coder (CIC), Certified Outpatient Coder (COC), Certified Professional Biller (CPB) or other AAPC certification. Other certifications offered through HCCA, AAPC, or AHIMA

To Apply: For fullest consideration click on the Apply Now button, please fully complete all sections of the online application including adding your full work history with specific details of your duties & responsibilities for each position held. Fully complete the education, licensure, certification and language sections. You may upload a resume, cover letter, certifications, licensures, transcripts and diplomas within the application.

Please note that once you have submitted your application you will not be able to make any changes. In order to revise your application you must withdraw and reapply. You will not be able to reapply after the posting close date. Please ensure the application is fully completed and all supporting documents have been uploaded before the posting close date. Illinois Residency is required within 180 days of employment.

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The University of Illinois System is an equal opportunity employer, including but not limited to disability and/or veteran status, and complies with all applicable state and federal employment mandates. Please visit Required Employment Notices and Posters to view our non-discrimination statement and find additional information about required background checks, sexual harassment/misconduct disclosures, COVID-19 vaccination requirement, and employment eligibility review through E-Verify.

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