Coding Representative

The University of Iowa Health Care, Department of Pharmaceutical Care, is seeking a full-time coding representative to join our team. The Coding Representative is a Medical Coder position within UI Health Care Department of Pharmaceutical Care that supports delivering service excellence through high customer service, as well as accurate and compliant drug billing for multiple UI Health Care locations. The position requires strong verbal and written communication skills, a high level of attention to detail, a general knowledge of hospital billing practices and computer competency. The Medical Coders assigned to the Department of Pharmaceutical Care are responsible for working/monitoring pharmacy work queue charges and reviewing medical records for proper coding and billing compliance. In addition, the Medical Coders will work in coordination with the Patient Financial Services (PFS), Joint Office for Compliance (JOC), and other hospital departments throughout the organization to resolve pharmacy patient charge and coding discrepancies. While monitoring charges and applying proper billing codes as needed, this position will also respond to a variety of additional inquiries as they arise that require in-depth investigative analysis, interpretation, and charge resolution. The duties of the position will also provide billing assistance to the Investigational Pharmacy performing quarterly billing. The position is eligible to participate in hybrid remote work arrangement two days onsite/three days remote upon training completion. Remote work must be performed at an off-site location within the State of Iowa. Training will be held ONSITE at the HSSB building in Coralville, Iowa (Sep-Nov) /ACT Circle Pharmacy Building in Iowa City, Iowa (Dec-onward) at a length determined by the supervisor. Work arrangements will be reviewed annually and must comply with the University of Iowa remote work program and related polices and employee travel policy when working at a remote location

Position Responsibilities:

Key areas of responsibility

Review electronic medical record documentation to assign CPT/HCPCS and/or ICD-10-CM/PCS diagnosis and procedure codes consistent with coding compliance policies, ICD-10-CM/PCS Official Coding Guidelines, and regulatory guidelines.

Understand the basic principles, techniques, and terminology of claims processing and reimbursement by applying coding and payment rules/regulations.

Identify key health information coding concepts and features (CPT, HCPCS), and determine where and how to obtain additional health information.

Communicate with other UI Healthcare staff including physicians, residents, staff, and other providers when additional information is needed for accurate code assignment.

Identify key aspects of problem solving and utilize accepted procedures for problem analysis and resolution.

Monitor reimbursement activity for high-cost medications to ensure UI Health Care receives full and accurate reimbursement for pharmacy services in compliance with payor rules and regulations.

Investigate and resolve pharmacy charge denials, edits, and hold bills to produce accurate claims for submission.

Review and assess medical record documentation to support codes and/or identify missed billing opportunities.

Perform billing duties associated with Investigational Drug Service validating MFK’s, maintain records and track payments.

Enter drug utilization for pharmacy supply chain division which triggers the reorder point for replenishment.

Meet billing accuracy and volume expectations set by the Finance Manager.

Operation & Performance Standards

Utilize tools and processes to maximize the efficiency of the revenue cycle.

Resolve pharmacy billing code discrepancies and identify possible trends.

Identify potential process improvements, including denial management and programming updates.

Work with HCIS, department administration, finance and others regarding appropriate coding, billing and medical documentation.

Reporting

Research, investigate, and compile results of work list and other revenue cycle reports for submission to supervisor.

Monitor and provide follow up on the list of high dollar drugs for reimbursement.

Compile information for audits as they arise from compliance in a reportable manner.

Monitor reports to identify missed facility billing opportunities and educate trends.

Analyze and provide reports related to documentation issues, coding patterns, and reimbursement trends.

Validate, submit, and track drug dispensing/administrative service invoices for the Investigational Drug Service.

Communication/Training

Work in cooperation with department staff, HCIS, and others regarding billing procedures and revenue cycle issues and coding issues.

Understands the importance of effective business communication and maintaining professionalism in difficult situations.

Participate in internal coding and developmental training.

Technical Competencies

Knowledge of and ability to utilize data analysis tools to sort through and analyze data to identify factors influencing business performance.

Understands available resources throughout department and organization.

Ability to analyze situations fully and accurately and reach productive decisions.

Knowledge of tools for recognizing and resolving organizational, operational, or process problems.

Knowledge of an organization’s internal audit processes, practices, and methods.

Ability to perform audits to ensure organizational compliance.

EQUIPMENT

Onsite – the department will provide a workstation which contains 3(three) monitors, laptop/power cord, docking station/power cord, keyboard, mouse, headset and desk supplies

Hybrid – while working onsite, the department will provide a workstation which contains 3 (three) monitors, a laptop/power cord, docking station/power cord, keyboard, mouse, headset, and desk supplies. When working offsite, the employee will take their laptop/power cord to carry back and forth as well as headset. Prior to working offsite, the employee at their own expense will need to supply 2(two) monitors, a keyboard, a mouse and provide domicile internet speed (minimum 30mb download and 10mb upload) and picture of office setup.

Education Requirements:

Completion of a diploma or degree program in Health Information Management or related field or an equivalent combination of education and experience.

Eligibility for certification as RHIT, RHIA, CPC, CCS, CCSP or equivalent through a nationally recognized credentialing body such as AHIMA or AAPC. Must receive full certification within 6 months of hire.

Experience Requirements:

Experience and proficiency with computer software applications, i.e., Microsoft Office Suite (Excel, Word, Outlook, PowerPoint) or comparable programs.

Strong attention to detail and proven ability to gather and analyze data and keep accurate records.

Self-motivated with initiative to seek out additional responsibilities and assist other Medical Coders on the team.

Effective verbal and written communication skills, active listening skills, and the ability to maintain professionalism while handling difficult situations.

Demonstrate ability to follow policies and procedures while escalating issues as needed.

Basic knowledge and understanding of the Health Insurance Portability and Accountability Act (HIPAA)

Medical terminology knowledge.

Demonstrated ability to handle complex ambiguous situations with minimal supervision.

Desired Qualifications:

1 - 3 years’ experience medical coding and healthcare revenue cycle processes with insurance and/or federal and state assistance programs preferred but will consider applicants with less experience.

Working experience with multiple technology platforms such as Epic, Cirius, McKesson or VitalWare systems.

Knowledge, understanding and/or experience with CMS regulations or industry standards.

Current certification as RHI, RHIA, CPC, CCSP or equivalent.

Knowledge of anatomy and physiology

Position and Application Details:

In order to be considered for an interview, applicants must upload the following documents and mark them as a “Relevant File” to the submission:

• Resume

• Cover Letter

Job openings are posted for a minimum of 14 calendar days and may be removed from posting and filled any time after the original posting period has ended.

Successful candidates will be required to self-disclose any conviction history and will be subject to a criminal background check and credential/education verification. Up to 5 professional references will be requested at a later step in the recruitment process.

For additional questions, please contact Penni Berger at

Additional Information

Compensation

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