The primary purpose of this higher-level position is to manage, direct, and monitor all coding activity for the clinical departments at SIU Medicine Express Care and SIU Federally Qualified Healthcare Center Decatur SIU Center for Family Medicine, including but not limited to: direct management oversight of coding staff, assist with training and teaching continuous education to direct coding staff (RCR and RCS), clinical staff and providers, perform audits of clinical documentation in comparison to CPT code selection, analysis of coding denials to utilize in an audit capacity assisting in the education of coding staff, and provide support, input and applicable training for existing and new systems implementations as well as federal/state mandates. In addition, the employee will directly supervise coding staff and recommend standards of reimbursement and oversee the coding and billing of charges for all outpatient and inpatient charges. This position will serve as a primary administrative figure for the SIU Federally Qualified Healthcare Centers coding staff that provides coding support for SIU School of Medicine providers.

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60% - ADMINISTRATION & TEACHING
1. Interview, onboard, supervise, and evaluate all coding and billing business staff.
2. Maintain productivity coding statistics.
3. Assist in development and implementing policies for the SIU Federally Qualified Healthcare Centers coding and billing unit by payer type and by special billing program as assigned by the FQHC Deputy Director.
4. Set daily priorities for staff ensuring timely and appropriate coding and billing for reimbursement.
5. Research and stay abreast of new developments and policy changes at the national, state, and local levels with particular attention to Medicaid and Medicare coding/billing for FQHC's.
6. Research reimbursement rates and issues related to new services.
7. Investigate reimbursement of patient services by third party payer such as Managed Care Organizations and recommends any necessary changes to Deputy Director.
8. Resolves billing questions from SIU Federally Qualified Healthcare Centers patients, faculty, and staff.
9. Attend faculty/divisional meetings along with the Deputy Director to inform faculty and staff of new coding issues specific to their specialty and also of recurring problems with functions such as completion of charge ticket, etc.
10. Identify potential compliance issues and report to FQHC Deputy Director and/or Office of Compliance.

Note:
The following list represents areas where this position will have the responsibility of staying current and being the content expert:

* ENCOUNTER TYPES: This position is responsible for outlining and overseeing the process for coding and billing the following types of encounters:

o Encounter Rate Clinics for Medicare and Medicaid clinic visits - including billing for telehealth services.
o Nursing Home and Home Visits
o Inpatient and Other Hospital Billing
o Obstetrical and Newborn Billing
o Procedure Clinics
o Behavioral Health and Psychiatry
o Dietary and Nutrition
o Care Coordination Services

* PAYERS AND SPECIAL PROGRAMS: This position serves as a liaison with the following payers and special programs to insure appropriate and timely coding and billing:

o Medicaid - through Health and Family Services
o Medicare - through CMS and NGS
o Healthy Woman and Children Program - Illinois Dept of Public Health
o Vaccines for Kids Program and ICARE - Illinois Dept of Public Health

o Illinois Breast and Cervical Cancer Program - Sangamon County Dept of Public Health
o Wise Women Program - Sangamon County Dept of Public Health
o Managed Care Programs
o Commercial Programs
o Dual Eligible Programs
o Discounted Fee Schedule Program or Charity Care - FQHC Governing Board
o Workers Compensation & Accident Claims - Various Employers
o Medical Student Insurance Program - SIU Carbondale Student Health

* CODING AND BILLING: Stay abreast of recent developments in the coding and billing areas with particular attention to work flow processes for the following:

o Insure compliance with Physician Teaching Guidelines
o Audit TES edits to insure appropriate action is taken to correctly bill encounter
o Keep abreast of ICD-10 requirements
o Refinement of the electronic charge ticket in TouchWorks
o Meaningful Use and UDS criteria as it relates to coding and billing
o Patient Centered Medical Home concepts as it relates to coding and billing
o Billing changes for Federally Qualified Health Centers

* SERVES AS A SUPERUSER and not only be knowledgeable, but master and be able to train others on the following Health Information systems.

o Internal Systems:
* Athena IDX Practice Management System
* TouchWorks Electronic Medical Record System
o External Systems:
* Memorial Medical Centers
* Gerner PowerCharts
* Patient Keeper Electronic Billing system

35% - DIRECT CODING AND BILLING FOR REIMBURSEMENT
1. Provide expert advice and guidance to administrators, faculty, and staff regarding coding, documentation, and other third-party payer guidelines.
2. Research and advise faculty of new CPT and ICD-1O codes for proper use and billing requirements, including researching reimbursement rates and documentation requirements.
3. Assist in resolving complex account problems, specific to coding related issues/denials, and approve account maintenance adjustments in compliance with Department, University, and third-party payer guidelines.
4. Periodically audit chart notes to determine all appropriate charges were billed and notes are completed on a timely basis - report discrepancies to Supervisor.
5. Review coding and reimbursement rules and using appropriate resources to keep updated on policy changes. Communicate changes to faculty and staff.
6. Review documentation, including clinic notes and consultative and operative reports, to determine the appropriate level of evaluation and management services was provided as well insuring all procedures and modifiers are captured and submitted for billing.
7. Conduct training sessions for faculty, residents, administrators and staff on CPT and ICD10 coding and third party payer submission and billing guidelines based on outcomes of coding audits and denial analysis.
8. Assist with maintaining the Experian claim scrubber edit system which includes support to peers regarding questions related to edits, rules, workflows, etc. Create and modify edits as requested to address issues identified via audits, coding denials or result of new federal/state mandates.

5% - MISCELLANEOUS
1. Assist in posting charges for as needed to meet timely submission goals
2. Attend seminars and/or read publications to increase knowledge and understanding of CPT and ICD10 coding and billing processes as well as to remain up to date regarding reimbursement policies of payers such as Medicare, Medicaid and managed care payers.
3. Other duties as assigned.

1. High school graduation or equivalent.
2. Current certification as a Certified Coding Specialist (CCS) or Certified Coding Specialist-Physician-based (CCS-P) or Registered Health Information Technician (RHIT) or Registered Health Information Administrator (RHIA) by the American Health Information Management Association (AHIMA), or current certification as a Certified Professional Coder (CPC) or a Certified Outpatient Coder (COC) by the American Academy of Professional Coders (AAPC) (formerly CPC-H certification).
3. Three (3) years (36 months) of total work experience, two (2) years (24 months) of which are comparable to that performed at the Reimbursement Coding Specialist level of this series or in other positions of comparable responsibility.

If you require assistance, please contact the Office of Human Resources at or call 217-545-0223 Monday through Friday, 8:00am-4:30pm.

The mission of Southern Illinois University School of Medicine is to optimize the health of the people of central and southern Illinois through education, patient care, research and service to the community.

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Southern Illinois University School of Medicine is an Affirmative Action/Equal Opportunity employer who provides equal employment and educational opportunities for all qualified persons without regard to race, color, religion, sex, national origin, age, disability, sexual orientation, protected veteran status or marital status in accordance with local, state and federal law.

Pre-employment background screenings required.