The Reimbursement Coder works with patients, providers, clinic staff, and insurance carriers to ensure all insurance requirements for procedures, surgeries, and referrals
are met efficiently. This role performs prior authorizations using CPT and ICD-10 codes, assists Patient Financial Services with denial management, and communicates anticipated self-pay portions to patients. The Reimbursement Coder maintains current knowledge of major payer regulations, consults with clinical staff for procedural and diagnostic details, and collaborates with the hospital business office and admitting department to resolve complex claim issues and guarantee payment for scheduled services.
Qualifications:
• HS Diploma or GED equivalent, required.
• Three (3) years' experience in medical insurance industry, Two (2) years' experience in medical coding preferred.
Primary Duties and Responsibilities:
- Process assigned referrals, authorizations, and track approvals efficiently.
- Collaborate with clinic staff to identify patients needing pre-certification or pre-authorization and secure required approvals.
- Verify patient insurance eligibility, benefits, and pre-authorization requirements for procedures and services.
- Obtain patient or responsible party signatures for non-covered service waivers.
- Identify VA-eligible patients and secure appropriate referrals and authorizations.
- Assist Patient Financial Services with claim denials and appeal denials based on medical necessity.
- Refer patients to Patient Financial Services for Hospital Financial Assistance eligibility.
- Complete insurance request forms, including pre-existing conditions and medical necessity documentation.
- Coordinate pre-surgical authorizations with the hospital Patient Access department.
- Maintain current knowledge of Medicare, DMAP, and third-party payer requirements, and keep certification CEUs up to date.
Skills and Abilities:
- Excellent verbal and written communication.
- Ability to identify problems and find effective solutions.
- Proficient knowledge of anatomy, pathophysiology, medical terminology, ICD-10, CPT and HCPCS codes.
- Strong ability to multitask and manage time effectively in a busy clinic environment.
- Competent in using electronic health record (EHR) systems for documentation and ordering.
Physical Demands and Work Environment:
- Ability to sit and work at a computer for extended periods.
- Requires the ability to lift, move, or assist patients and equipment weighing up to 25 pounds.
- Must be able to perform the primary duties and responsibilities of the job with or without reasonable accommodation.
Compensation: $23.69-$32.66 DOE
Expectations for All Employees
Support the organization's mission, vision and values by adhering to the behavioral standards of Grande Ronde Hospital. Comply with all laws and regulations affecting Grande Ronde Hospital. Be familiar with and adhere to the Personnel Policy Manual and the Code of Conduct and support the Grande Ronde Hospital Compliance Program. Effective communication skills and the ability work effectively with people from various backgrounds are critical.
Benefits
- Health Insurance
- Vision Insurance
- Dental Insurance
- Flexible Spending Account (FSA and Health Savings Account (HSA) Options
- 401K Plan with Roth Options
- 401K 3% employer match and a 2% base non-elective employer contribution
- Eligibility for company-paid benefits such as life insurance and long-term disability, subject to applicable waiting periods
- Option to elect Supplemental employee, spouse, and child life insurance
- Paid Time Off (PTO)
- Access to the Employee Assistance Program
- Discounts: available for meals in the cafeteria and over-the-counter pharmacy items
- Exercise/Fitness Facility: access to the Rehab Therapy Fitness Center for the employee and dependents
Mission: Grande Ronde Hospital and Clinics will ensure access to high quality, cost-effective health care in a safe and customer-friendly environment for all those in need of our services.
Vision: Quality health care is our mission. Patients are our passion.
Values: Creativity, Compassion, Collaboration, Credibility
Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.