Claims Coding Specialist

Description

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Summary:

We're a small but mighty 340B HTC specialty pharmacy serving about 300 patients with bleeding disorders throughout the State of North Carolina. The position will handle billing of these medications to our patients' health plans from start of referral to payor reimbursement back into our system; this includes benefits investigations and daily claim filing (both pharmacy and medical).

Performs complex duties in support of reimbursement from patients and insurance carriers for the assigned clinical department. Duties include reversing denials from carriers, recoding denied claims, and identifying coding trends. Substantial knowledge of all carrier policies, procedures and practices is required to collect carrier accounts receivable, reverse denials, and expedite coverage to the uninsured. In addition, work requires knowledge of coding, but not to the extent of classes in the Medical Coder series.

The position will be a hybrid role - on-site Monday through Thursday at our Chapel Hill Quadrangle location, and remote on Fridays.

Responsibilities:
1. Collaborates with internal staff and Clinical departments regarding filing, documentation and reimbursement issues. Works closely with clinic staff to modify documentation, filing processes, and encounter forms to enhance billing and collection process
2. Evaluates accounts, billing, payments, coding, and posting of accurate charges for a highly specialized and complex medical service such as transplant. Researches and resolves denied claims with carrier and patients.
3. Identifies coding trends that do not support maximum reimbursement. Makes recommendations that will prevent or correct identified coding errors
4. May serve as a lead worker to provide problem resolution and assistance to lower level positions.
5. Researches and determines if carrier denial of claim is valid and if not, abstracts information from medical records to support appeal of carrier denials. Makes changes to original coding of charges in accordance with ICD-9 and CPT codes.
6. Serves as a resource for physicians, insurance carriers and patients to resolve questions/problems pertaining to patient accounts.

Education Requirements:
* High School diploma or GED
Licensure/Certification Requirements:
* No licensure or certification required.
Professional Experience Requirements:
* Three (3) years of experience in a clerical, accounting or customer service setting.
* Six (6) months of experience working with CPT and ICD-10.
Knowledge/Skills/and Abilities Requirements:

Legal Employer: STATE

Entity: UNC Faculty Physicians

Organization Unit: Hemophilia Treatment Center

Work Type: Full Time

Standard Hours Per Week: 40.00

Salary Range:$19.78 - $28.12 per hour (Hiring Range)

Pay offers are determined by experience and internal equity

Work Assignment Type: Hybrid

Work Schedule: Day Job

Location of Job: US:NC:Chapel Hill

Exempt From Overtime: Exempt: No

This is a State position employed by UNC Health Care System with UNC Health benefits. If, however, you are presently an employee of another North Carolina agency and currently participate in TSERS or the ORP, you will be eligible to continue participating in those plans at UNC Health.

Qualified applicants will be considered without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, genetic information, disability, status as a protected veteran or political affiliation.

UNC Health makes reasonable accommodations for applicants' and employees' religious practices and beliefs, as well as applicants and employees with disabilities. All interested applicants are invited to apply for career opportunities. Please email applicant.accommodations@unchealth.unc.edu if you need a reasonable accommodation to search and/or to apply for a career opportunity.