Reimbursement Coding Specialist - Summit Therapy & Health Services

Pay Range:

Wage offered depends on job-related experience, knowledge, and skills.

HOURS: Monday-Friday 8-5

JOB SUMMARY:

The Reimbursement Coding Specialist at Summit Therapy & Health Services verifies insurance coverage and benefits and investigates codes for reimbursement. The Coding Specialist also obtains pre-authorizations when needed, will research insurance denials, and submit appropriate medical records for payments. On occasion this professional will also provide coverage for the front office.

QUALIFICATIONS:

Education/Training: High school diploma or equivalent

Experience: No experience required, administrative experience preferred

Population Served: Adolescent, Young Adult, Middle Age, and Elderly.

ESSENTIAL FUNCTIONS:

Planning and Prioritizing

Research all admitted patients insurance previous to service for Out Patient Services. Answers and routes incoming calls when needed. Enters charges and researches any denials in a timely manner.

Information Gathering

Obtains consents for admission, treatment, and insurance billing purposes. Research all patients insurance and coverage previous to service. Communicates with other organizations to gather patient information that is needed prior to patient arrival. Assists Patient Registration with coverage as needed. Works closely with Billing department with information needed to process claims in a timely manner.

Decision-Making

Assists with appropriate billing and coding as needed.

Communication

Communicates appropriately with patients, coworkers, physician offices as well as members of ancillary departments throughout the hospital and any other individual necessary to perform essential job functions. Answers or sources patient inquiries to the appropriate party. Maintains accurate records and documentation on mainframe computer system.

Technical Proficiency

Prepares and releases copies of medical records required by Lawyers, Insurance Companies and other Medical Offices. Registers all patients quickly, efficiently, and accurately. Enters charges in a timely manner. Obtains verifications of insurance authorizations. Research and manage potential denials.

Teamwork

Assists Director with special projects or assignments as needed. Assists billing office when necessary to process claims. Work with HIM as needed to process claims. Works with teams for special scheduling of groups/cases.

Quality

Helps to ensure a timely processing of patient billing and outcomes.

Outcomes

Participates in committees or task forces as requested or required.

Personal Education

Attends ongoing educational activities as necessary to acquire and maintain competency in admissions compliance by attending conferences, seminars and reading appropriate material. Attends regular staff meetings.

Work Effectiveness

Demonstrates the ability to care for a reasonable workload. Maintains flexibility in the changing needs of ones role as the field.

Reliability

Demonstrates promptness in reporting to work and compliance with meal and break schedules. Completes requested information in a timely fashion. Takes initiative to do other duties as needed.

Communication and Education

Communicating and educating other staff members on any changes that will affect their patient care.

Creating a Safe Work Environment

Identifies safety concerns and actively seeks to resolve these issues.

Stewardship

Assumes the willingness to be accountable for the well-being of the larger organization by operating in service, rather than in control, of those around us.

Ethical Conduct

Consistently communicates and collaborates with colleagues about decisions which involve legal and ethical issues.

NON-ESSENTIAL FUNCTIONS:

Faxes information as requested. Requisitions supplies and forms. Performs other non-essential functions as requested.

PHYSICAL DEMANDS:

Sitting: 50%. Standing/Walking: 50%.

Occasional lifting/carrying of supplies and equipment weighing up to 30 pounds.

Occasional pushing/pulling of wheelchairs weighing over 200 pounds.

Occasional climbing of stairs to reach other levels of the building.

Occasional stooping/kneeling to reach items on low shelves and to get into low cabinets.

Occasional reaching/handling to complete paperwork.

Frequent fingering to operate switchboard and computer.

Constant talking/hearing/seeing to interact with patients, staff and visitors.

ENVIRONMENTAL CONDITIONS:

Location: Inside.

Frequent exposure to noise may cause distraction.

Minimal risk of injury due to proximity of moving parts on computer printer, typewriter, and copier.

Minimal exposure to biohazardous materials.

Minimal exposure to drafts.

We believe Pullman Regional Hospital is extraordinary.

We are an independent, patient and employee-focused, award-winning organization with a unique, collaborative and inclusive culture.

On a daily basis, our 600+ employees serve patients and communities through Pullman Regional Hospital, the Foundation, and our growing network of clinics. We are one of the largest employers in Pullman, WA, and a community leader in healthcare activities. Together, we continue to raise the bar of expectation for quality healthcare and the patient experience. In this way, the extraordinary for all others becomes the expected at Pullman Regional.

Our greatest asset is our people. That’s why we hire passionate people who are aligned with our mission to nurture and facilitate a healthier quality of life for our region.

If you have a passion for health and healing, enjoy helping people, and want to work for an organization that values a growth mindset, we can’t wait to meet you!