Disability Determination Remote Jobs in Raleigh, NC

Description

Your passion belongs at UNC Health. Join more than 56,000 teammates working together to improve the health and well-being of the communities we serve across North Carolina.

Summary:
Performs technical and administrative work reviewing, abstracting and assigning accepted medical CPT, HCPCS, and ICD-10 codes for professional services. Duties are performed in compliance with third party, state and federal regulations according to standardized procedures. Employees report to an administrative superior but independently handle assigned tasks. 

Responsibilities:
1. Assigns International Classification of Diseases (ICD-10-CM) diagnosis codes in an accurate and productive manner.
2. Assigns all codes to chronic conditions documented that may impact Hierarchal Condition Categories (HCCs) or expected mortality.
3. Assigns Healthcare Common Procedure Coding System (HCPCS) and Current Procedural Terminology (CPT) codes in an accurate and productive manner.
4. Groups codes and completed product into payment groups. Analyzes information for optimal and proper reimbursement.
5. Reviews National Coverage Determination (NCD), Local Coverage Determination (LCD), and Correct Coding Initiative (CCI) edits and any other coding edits and applies changes to code assignments appropriately, and/or adds modifiers appropriately.
6. Recognizes and has knowledge of Medical Necessity requirements and resolves edits during code assignments.
7. Ensures compliance with all appropriate coding, billing and data collection regulations and procedures.
8. Provides information to physicians and other health care staff regarding current coding practices and changes in 3rd party, state and federal regulations and guidelines.
9. Reviews, analyzes and abstracts physician/other documentation for diagnoses and other services provided.
10. Obtains missing information and/or clarifies existing information.
11. Accepts feedback from Auditor as needed to avoid future errors.
12. Accepts feedback from PWC Smart reviews and makes edits as needed to avoid future errors.
13. Reviews and processes PWC SMART edits.
14. Researches appropriate databases for validation of information.
15. Utilizes a variety of software (e.g. Epic, Optum CAC, MS Office, etc.) to compile and validate medical information.

Other information:
Education Requirements:
High School diploma or GED Successful completion of the UNC HCS Hospital OP Coder Proficiency Test.
Licensure/Certification Requirements:
Must have one of the following: - AHIMA (American Health Information Management Association) certification and credential - AAPC (American Academy of Professional Coders) certification and credential
Professional Experience Requirements:
Two (2) years of experience in hospital coding.
Knowledge/Skills/and Abilities Requirements:
Strong knowledge of ICD-10-CM and HCPCS/CPT coding with excellent analytical and data mining skills. Strong knowledge of Ambulatory Payment Classification (APC) system for outpatient cases. Ability to effectively manage projects. Ability to effectively work with various levels of staff (including on-site and remote). Must possess strong communication skills, both written and verbal and have extensive attention to detail. Exhibits effective organizational skills, time management, and management of multiple priorities. Ability to interpret complex medical conditions and work with complex coding applications. Ability to have an excellent balance of being highly productive and yet produce high quality work. Ability to interpret federal and state regulations as they relate to coding and compliance.

Legal Employer: NCHEALTH

Entity: Shared Services

Organization Unit: HIM Hospital Coding

Work Type: Full Time

Standard Hours Per Week: 40.00

Salary Range: $24.98 - $35.91 per hour (Hiring Range)

Pay offers are determined by experience and internal equity

Work Assignment Type: Remote

Work Schedule: Day Job

Location of Job: US:NC:Chapel Hill

Exempt From Overtime: Exempt: No

This position is employed by NC Health (Rex Healthcare, Inc., d/b/a NC Health), a private, fully-owned subsidiary of UNC Health Care System, in a department that provides shared services to operations across UNC Health Care; except that, if you are currently a UNCHCS State employee already working in a designated shared services department, you may remain a UNCHCS State employee if selected for this job.

Qualified applicants will be considered without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, genetic information, disability, status as a protected veteran or political affiliation.
UNC Health makes reasonable accommodations for applicants' and employees' religious practices and beliefs, as well as applicants and employees with disabilities. All interested applicants are invited to apply for career opportunities. Please email applicant.accommodations@unchealth.unc.edu if you need a reasonable accommodation to search and/or to apply for a career opportunity.