POSITION SUMMARY:

The Medical Records Coder IV, Lead will act as a resource to PFS staff as well as PFS Coders, serving as a focal point for answering coding related questions & researching coding related issues on difficult accounts. Resolves complex problems that require a high level of expertise and knowledge of clinical coding, charge capture, charge entry and systems including investigating and resolving matters of significance on behalf of designated leader. The Medical Records Coder IV, Lead will also work with department representatives and Revenue Integrity to develop hospital charges for services provided in clinical areas through the Charge Master Request Form. Review requests for new DEP locations to assure Charge Master set up.

TYPICAL DUTIES:

• Work with department representatives & Revenue Integrity to develop hospital charges for services provided in clinical areas through the Charge Master Request Form. Collaborating with Clinical Department Administrators, HIM and Compliance to establish that appropriate documentation for services is maintained as well as researching coverage issues with major payers. Review requests for new DEP locations to assure Charge Master set up.

• Acts as a resource to PFS staff as well as PFS Coders; serves as a focal point for answering coding related questions & researching coding related issues on difficult records. This would include responding to non-routine and complex requests, inquiries or problems. Resolves complex problems that require a high level of expertise and knowledge of clinical coding, charge capture, charge entry and systems. Investigates and resolves matters of significance on behalf of designated leader.

• Work with staff & management in Patient Financial Services, Information Systems team and Ambulatory Areas to resolve claim denials due to improper codes (CPT/HCPCS & ICD-10 diagnosis), modifiers and billing procedures & rules. Analyze reasons for denials and collaborate with PFS Billing Analysts/Coders to provide Billing Managers and staff with education on proper coding and hospital billing rules.

• Assists with resolving hospital outpatient claims that are unbilled due to Medicare/Medicaid APC/APG grouper holds and edits. SMH Claim Edit WQ.

• Review all bulletins and notices from third party payers, LCD/NCD updates, contact ambulatory areas to exchange pertinent information to implement changes to the hospital Charge Master as a result of regulatory and payer changes, assuring compliance with Medicare, Medicaid and other third-party requirements.

Other duties as assigned

QUALIFICATIONS:

• HS Diploma required.

• Associate degree with 2-4 year’s experience in Hospital Billing & reimbursement preferred.

• Minimum of 3 years’ experience as Medical Coder required.

• Additional coding experience in area of assignment preferred.

• or equivalent combination of education and experience required.

• Knowledge of ICD-10, CPT4 & HCPCS Codes required.

• Working knowledge of medical terminology and anatomy required.

• Excellent communication skills (oral & written) preferred.

• Experience in Microsoft programs, including Excel & Outlook preferred.

• CPC/CCS in good standing and maintained through continuing education required.

The University of Rochester is committed to fostering, cultivating, and preserving a culture of equity, diversity, and inclusion to advance the University’s mission to Learn, Discover, Heal, Create – and Make the World Ever Better. In support of our values and those of our society, the University is committed to not discriminating on the basis of age, color, disability, ethnicity, gender identity or expression, genetic information, marital status, military/veteran status, national origin, race, religion/creed, sex, sexual orientation, citizenship status, or any other status protected by law. This commitment extends to the administration of our policies, admissions, employment, access, and recruitment of candidates from underrepresented populations, veterans, and persons with disabilities consistent with these values and government contractor Affirmative Action obligations.

How To Apply

All applicants must apply online.

EOE Minorities/Females/Protected Veterans/Disabled

Pay Range

Pay Range: $25.53 - $35.75 Hourly

The referenced pay range represents the minimum and maximum compensation for this job. Individual annual salaries/hourly rates will be set within the job’s compensation range, and will be determined by considering factors including, but not limited to, market data, education, experience, qualifications, expertise of the individual, and internal equity considerations.

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Location: Strong Memorial Hospital
Full/Part Time: Full-Time
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