UNM Medical Group
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Account Operations Coding Tech
at UNM Medical Group
UNMMG AR & Denial Management
# of Openings:
Job Code/Title: B0010 / Account Ops Coding Tech
FLSA: Non- Exempt
BEST CONSIDERATION DATE: OPEN UNTIL FILLED
UNM Medical Group, Inc. (UNMMG) is the practice plan organization for physicians and other medical providers associated with the UNM Health Sciences Center. UNM Medical Group, Inc. is a New Mexico non-profit corporation and is an equal opportunity employer. UNMMG offers a competitive salary and an attractive benefit package which includes medical, dental, vision, and life insurance as well as tuition assistance, paid leave and 403b retirement for benefits eligible employees.
UNMMG AR & Denial team is looking for a analyst to research and provide feedback on coding related issues regarding coding denials. Identify coding issues and create TES edits. Work with AR and Follow Up and Coding departments to identify coding issues. Will review escalations from the AR and Follow Up team on coding related denials and issues. Resposibile for analysys as well as resolution of coding edits.
The following statements are intended to describe, in broad terms, the general functions and responsibility levels characteristic of positions assigned to this classification. They should not be viewed as an exhaustive list of the specific duties and prerequisites applicable to individual positions that have been so classified.
Under general supervision, performs a variety of complex functions to resolve involved billing problems and issues regarding coding denials. Researches and provides feedback on coding related issues. Identifies coding issues and works closely with both the AR and Follow Up and Coding Departments. Performs complex analyses of coding related issues in regards to AR and Follow up. Will review medical record documentation to ensure correct coding, Provides day-to-day guidance regarding coding to AR Department.
Duties and Responsibilities
- Responsible for coding issues escalated by the Accounts Operations team.
- Responsible for review and analysis of medical records for all professional fee CPT and ICD-10 codes to determine appropriate coding as it relates to payer denials.
- Responsible for analyses as well as resolution of coding edits that occur.
- Interacts with and advises internal AR staff regarding coding and documentation policies, procedures, and serves as liaison with other department representatives to resolve coding related issues.
- Responsible for providing feedback to Coding Department when necessary regarding coding and documentation.
- Responsible for creating edits regarding payer specific issues regarding coding.
- Ensures strict confidentiality of patient medical and financial records, in compliance with federal and state patient privacy legislation.
- Assists in departmental problem solving, project planning, and the development and execution of departmental goals and objectives.
- Performs miscellaneous job-related duties as assigned.
Minimum Job Requirements
High school diploma or GED with at least 5 years of experience directly related to Accounts Receivable and 6 months directly related to coding. Certificate in at least one of the following: RHIT, RHIA, CSS, CCA, CCS-P, COC, CIC, CPC, CPC-P or CPC-A. Verification of education and licensure (if applicable) will be required if selected for hire.
Knowledge, Skills and Abilities Required
- Ability to identify and resolve reimbursement and credit balance issues related to all medical insurance payer groups.
- Ability to communicate effectively, both orally and in writing.
- Ability to use independent judgment and to manage and impart confidential information.
- Ability to utilize an automated accounting system.
- Knowledge of state and federal patient privacy of information legislation.
- Knowledge of rules governing primary/secondary responsibility and patient responsibility after third party payments and denied services.
- Working knowledge of medical terminology, anatomy and physiology, HCPCS, ICD-10 and CPT coding.
- Knowledge of professional fee E&M and procedural coding and ability to review medical records to identify billable services and assign codes appropriately.
- Knowledge of legal and regulatory guidelines pertaining to coding practices and procedures.
- Ability to gather, compile and analyze data.
- Knowledge of general accounting principles.
- Ability to calculate numbers, determine incorrect entries, and post corrections to records.
- Knowledge of computer spreadsheet software.
- Research, analytical, and critical thinking skills.
Conditions of Employment
- Must be employment eligible as verified by the U.S. Dept. of Health and Human Services Office of Inspector General (OIG) and the Government Services Administration (GSA).
- Must pass a pre-employment criminal background check.
- Fingerprinting, and subsequent clearance, is required.
- Must provide proof of varicella & MMR immunity or obtain vaccinations within 90 days of employment.
- Must obtain annual influenza vaccination.
- If this position is assigned to a clinical area, successful candidate will be required to complete a pre-placement medical evaluation/health screen. Required N-95 mask fitting, testing, vaccinations to include annual TST, Tdap, and Hepatitis B will be determined based on location and nature of position.
Working Conditions and Physical Effort
- Work is normally performed in a typical interior/office work environment.
- No or very limited exposure to physical risk.
- No or very limited physical effort required.