Job Requisition Number: 24327. UC Berkeley's Student Health Insurance Office is seeking an experienced Medical Coder and Billing Analyst.
The Student Health Insurance Office (SHIO) is located within UC Berkeley’s University Health Services at the Tang Center. SHIO Highlights: •Responsible for the administration of the University of California’s mandatory Berkeley Student Health Insurance Plan (Berkeley SHIP) which is billed as part of the campus registration fees each semester. •Coordinates all member services for students enrolled in Berkeley SHIP, and conducts the insurance “waiver” program for students. •Coordinates the insurance program for student athletes in Intercollegiate Athletics.
University Health Services at the Tang Center provides comprehensive medical, mental health, insurance and health promotion services to all Berkeley students, and a variety of health programs for faculty and staff. Approximately 65,000 visits occur annually including Primary Care, Urgent Care, Occupational Health and Specialty Clinics. Services are designed to minimize the impact of illness, emotional distress and injury on studies and work. Learn more about UHS by visiting https://uhs.berkeley.edu/employment
The Medical Coder and Billing Analyst is responsible for the development, implementation, and maintenance of processes for managing all aspects of medical claim coding for all services offered at the University Health Center. This includes analyzing of medical records and medical information to determine appropriate coding documentation on medical claims, and assisting in preparing, resolving and reconciling claims. Full responsibilities include:
I. Interpret clinical data and medical information to medical coding using ICD-10 CM, CPT Standard, and HCPCS Standard coding systems. Maintain a high level of coding accuracy and timeliness to assure claims are billed in a timely manner. Participate regularly in coding audits of the providers and coding educational sessions with providers. •Assign and sequence all codes for services rendered •Follow with providers on clarification of documentation. •Report any coding irregularities to the billing supervisor. •Accurately input codes and abstract data into the current Electronic Health Record (EHR) system. •Participate regularly in coding audits and coding educational sessions with providers. Provide feedback and training on annual coding updates. •Conduct audits and coding reviews to ensure all documentation is accurate and precise •Collaborate with billing department to ensure claims all are satisfied in timely manner •Contact physicians and other healthcare professionals with questions about diagnosis, treatments or diagnostic tests given to patients with regard to coding accurately and appropriately •Knowledge of current medical terminology, disease processes, anatomy & physiology and current coding guidelines •Working knowledge of current EHR system to be able to make updates and changes necessary for the system to be current and compliant •Review claims in the current EHR system that are stalled in the revenue cycle due to coding issues •Assist in submission of claims for payment through the current EHR system •Understand and maintains patient confidentiality and IT security II. Functions as a resource to support staff on issues such billing claims, denial management, escalated customer service problems and vendor concerns as it relates to coding issues. Assist operations to: •Correct claims where the carrier’s payment may be misaligned with plan design. •Review and resolve any claims that have been on HOLD status to resolve payment or billing issues. •Review and processing of “unauthorized tickets” in a timely manner due to coding issues •Research and resolve outstanding claims on aging reports for medical, mental health for all periods of time, but particularly all claims greater than 60 days old in the Account Receivable (A/R) •Correct coding errors in data entry (i.e.; wrong visit CPT, incorrect billing codes, etc.) •Review claims transaction reports daily to capture detail related to denials. Identify and make corrections to denials, alerting IT or HIM of chronic denials due to coding or system configurations.
III. Prepares reports and analyses to include summaries of codes most used, evaluation of current and proposed coding practices, denials due to coding errors etc., for management review and decision-making. •Review and correct regularly denials due to coding errors. •Review annually coding changes and provide updates to managers, supervisors and providers. Assists with ensuring that financial processing functions which may include Accounts Payable, Accounts Receivable, Cashiering and Collections are performed with accuracy and that daily operations run smoothly. •Knowledge of cash collections directly from students from service rendered at the UHS •Knowledge of what benefits may be covered at 100% under the Affordable Care Act •Completed and maintain annual compliance training on credit card process and handling. •Working knowledge of the functions of the Cashier Department Functions as a resource to support staff on issues such as researching complex financial discrepancies, escalated customer service problems and vendor concerns. Assist operations to: •Provide customer service to student/patients who need assistance in resolving issues with their share of cost for services rendered. •Provide customer service to students/patients pertaining to their financial responsibility for services rendered at UHS. •Maintain current, accurate knowledge of Berkeley SHIP policies in order to explain benefits and limitations of the plan to clients when discussing claims. •Verify patient’s Berkeley SHIP enrollment status and work with Berkeley SHIP benefits counselors to determine appropriate claims payment. •Review questions that may arise related to care at UHS and in the community; may include explaining an EOB to a patient and working with carrier to help in resolution. Claims payment and adjustment calls for other third party payers: accept calls and resolve requests from students who require a copy of their bill on a HCFA form and not in a Walkout Statement form
IV. Subject-Matter expert in coding issues.
V. Participates in audits of coding and processes and prepares recommendations for changes as needed•Two plus years’ experience coding and abstracting in an health care facility •Employment experience in the medial health industry, including but not limited to, medical coding (outpatient and or inpatient claims), insurance billing, insurance adjudication, customer service with benefits counseling or claims processing. Direct experience with, or knowledge of, medical claims processing for a major medical health insurance plan. •Working knowledge of financial processes, policies and procedures. •Knowledge of ICD-9, ICD-10-CM, CPT standards, HCPCS National Level II coding systems •Knowledge of medical coding with the ability to translate medical notes and medical information into universally used alphanumeric codes. •Accurately input codes and abstract data into current coding systems •Meet or exceed department production and quality standards for coding level •Follow up and clarify provider medical documentation •Knowledge of financial data management and reporting systems. •Must be proficient in use of Microsoft Office and common desktop/web applications. •Strong interpersonal skills, analytical skills, service orientation, active listening, critical thinking, attention to detail, ability to multi-task in a high volume environment, organizational skills, effective verbal and written communication skills, sound judgment and decision-making. •Knowledge of medical coding sufficient to verify completeness and accuracy of coding on insurance claims. •Uphold high standards of customer service in a demanding and complex health care organization. •Excellent communication skills, both written and verbal. •Excellent research and problem-solving skills. •Ability to function under fluctuating workloads, with frequent distractions and interruptions, and complete heavy workloads within established time frames. •Strong organizational skills to coordinate multiple, varied billing processes simultaneously. •Demonstrated strong interpersonal skills to build effective, professional working relationships with a diverse student customer service base, and diverse staff in a complex organizational structure. •Ability to handle sensitive information (HIPAA/FERPA) and to maintain confidentiality. •Well-developed touch typing/computer skills. •Functional knowledge of Practice Management System, Windows NT and the Microsoft Office suite, including word-processing, spreadsheet, and database programs. •Ability to pay attention to and manage detailed insurance information. •Demonstrated initiative, resourcefulness, integrity and dedication to timeliness to achieve high customer satisfaction levels.
Education: •Bachelors Degree in related area or equivalent experience/training.
Licenses or certifications: •Medical coding certificate is required At least one of the following certifications: •CPC (Certified Professional Coder) •COC (Certified Outpatient Coder) •CCS (Certified Coding Specialist) •RHIT (Registered Health Information Technician) •RHIA (Registered Health Information Administrator) 100% FTE, 1-Year Contract appointment.
Employment is contingent on successful completion of: Background Check, Acceptable Medical Evaluation that includes infectious disease surveillance and proof of current required vaccinations or immunity levels, and successful credentials verification (if applicable).
The University of California was chartered in 1868 and its flagship campus - envisioned as a "City of Learning" - was established at Berkeley, on San Francisco Bay. Today the world's premier public university and a wellspring of innovation, UC Berkeley occupies a 1,232 acre campus with a sylvan 178-acre central core. From this home its academic community makes key contributions to the economic and social well-being of the Bay Area, California, and the nation.