Coding Specialist 2

University of MinnesotaTwin Cities

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About the Job

The University of Minnesota's School of Dentistry (SOD) is seeking a Coding Specialist 2 to support all departments with medical coding needs, including Oral Surgery, Periodontics, and Oral Facial Pain. This role involves reviewing and correcting claim rejections, appealing denials, and analyzing electronic health records (EHR) to apply appropriate ICD-10, CPT, HCPCS, and CDT codes based on services provided and SOD billing policies / industry standards.

This position will be located onsite at Moos Tower for the first 6 months, and may have the ability to move to a hybrid schedule (3 days in office, 2 days remote) after probation and training.

This is a full-time (40 hours / week) position.

The work schedule is Monday-Friday 8-4 : 30

POSITION RESPONSIBILITIES

SOD Coding Support 20%

Serve as resource person for coding and compliance questions for TMD, Radiology, Prosthodontics, Periodontics, OMS, Special Health Needs Clinic and other clinics that may need it. Instruct physician and non-physician practitioners (Includes residents, students, and faculty members) on compliance regulations and coding guidelines and documentation.
Create and deliver presentations for ongoing education for students, residents, and faculty to educate on current coding changes and / or presentations on code and / or procedure groups and then type of documentation needed for billing and prior authorization
Create and maintain training material and update as needed.
Research and problem solve reoccurring claim rejections due to coding issues.
Create and keep an open line of communication with SOD clinics and their doctors (OMS, radiology, TMD, perio, etc)
Review EHR documentation for other clinics that need help with coding and provide appropriate CPT / CDT / ICD-10 / HCPCS codes.
Work with clinics that utilize charge masters, check out forms, and order forms to insure they have the most current CPT / CDT / ICD-10 codes on the charge masters.
Review medical claims rejections for the claims department.
Work with the claims department and providers to write letters of medical necessity as needed for claim denials.
Research problem claims identified by the claims department, compare coding with medical and / or dental record documentation and make any appropriate changes.
Identify and problem solve reoccurring claim rejections due to coding issues and / or documentation issues and provide individual and group training as needed to limit reoccurring rejections.
Identify and problem solve reoccurring claim denials rejections due to coding issues and / or documentation issues and provide individual and group training as needed to limit reoccurring rejections.
Call insurance company and / or research individual insurance policies on claim rejections and / or claim denials to limit claim delays due to possible coding or documentation issues and provide individual or group training as needed.
Answer coding questions from providers and other staff as needed.
Educate clinics on proper use of ABNs and non-covered service agreements (NCSA). Work with the clinics to implement a process to identifying accounts that require signed ABNs or NCSA and getting patient signatures. Educate staff on proper use of modifiers when posting charges for accounts with ABNs / NCSA.
Answering phones, triage of calls from patients, Fairview-University Medical Center, residents, doctors, other providers within U, front desk, and records requests.

OMS / TMD / CPC Clinic and OR Coding Support 60%

Use Axium to review and analyze student, resident, faculty EHR notes for each patient encounter for proper coding and billing compliance, accuracy and completion based in coding guidelines and regulations and School of Dentistry policies and procedures

Ensure all medical records / charts have been set up to be signed by faculty and have an attestation, if required

Track all EHR notes and / or compliance issue until problem is solved.

Meet with and explain to dental students and residents the complex compliance regulations and coding guidelines, established coding guidelines, and the policies of the School of Dentistry for proper EHR documentation

Apply proper CPT / CDT / HCPCS / ICD-l0codesto a patient's account based on your analysis of the

complete EHR documentation and within the complex compliance regulations and coding guidelines, established coding guidelines, and the policies of the School of Dentistry.

Apply all proper claim information required for a clean claim : the place of service, in-patient dates, referral information, and prior authorization information.

Use EPIC electronic charts to retrieve OR reports and / or inpatient consults and apply proper CPT / CDT / HCPCS / ICD-10codes to a patient's account based on your analysis of the complete EHR documentation and within the complex compliance regulations and coding guidelines, established coding guidelines, and the policies of the School of Dentistry.

Create Axium charts when required and attached any Epic documentation required for the School of Dentistry to submit and process claims properly

Provide account audits, and identify and track issues and concerns resulting from EHR review. Ensure issues are resolved. Provide reports of continued student / resident EHR documentation and coding issues to the OMS coding supervisor and team for continued education for students and residents and coding team.

Provide reports and consult with faculty when necessary for reasons of clarifications of coding and compliance Issues after routine account audits.

Prior Authorizations (PA) 20%

Support OMS in submitting prior authorizations as needed and support other clinics within the SOD to submit medical prior authorizations as needed.

Research and track each insurance company's prior authorization requirements for the different treatments provided by OMS.

Utilize the check out forms to identify cases that require medical and / or dental prior

authorization and track them.

Analyze EHR notes and records from other providers to determine medical necessity.

Prepare letters of medical necessity

Submit prior authorization and apply proper CPT / CDT / HCPCS / ICD-10 codes via the patient's insurance company. Comply with the insurance's submission requirements and where to send prior authorizations

Track and follow up on all prior authorization request submissions.

Provide routine reports to providers of current status of outstanding prior authorizations

Routinely meet with and explain to dental students, residents, and faculty the complex policies and requirements of each insurance company's unique documentation requirements to ensure for proper EHR documentation to support medical necessity

Track and document all communication and encounters with insurance companies in regards to PA requests.

Process authorization decisions properly based on the type of procedure being performed. This

will include communication with the clinic and / or OR coordinators, communicating with the patient, communicating with OMS doctors and other doctors involved in the patients care.

Review denials and appeal when required

Qualifications

All required qualifications must be included in the application materials

Required Qualifications

Bachelor's Degree or a combination of education and relevant experience totaling four years

CCS-P or CPC certification

Knowledge of :

Medical Terminology

CPT, ICD 10-CM and HCPCS Coding systems

Health information and medical record documentation, data integrity and quality

Medicare / Medicaid billing rules and other Federal Regulations for billing and third-party insurer billing policies and contract requirements

HIPAA regulations

Preferred Qualifications

Minimum of two years as a practicing outpatient / clinic coder.

Minimum of one year dental coding experience

Minimum of one year OMS coding experience

Experience in TMD / PT / Cleft and craniofacial coding

Knowledge of Axium and Epic

Experience with Medicare, Medicaid and other third-party payer reimbursement.

Knowledge of State and Federal laws governing billing and coding practices.

Excellent written and verbal communication skills.

Ability to organize work efforts and follow through on projects independently.

Ability to maintain confidentiality.

Presentation skills.

About the Department

The University of Minnesota is the state’s only dental school and the only dental school in the northern tier of states between Wisconsin and the Pacific Northwest. The School of Dentistry advances health through scientific discovery, innovative education, and the highest quality care for all communities. Our impact extends beyond dental offices to classrooms and clinics throughout the region. We educate dentists, dental specialists, dental therapists, dental hygienists, dental educators, and research scientists.

Pay and Benefits

Pay Range : $52,291-$86,257; depending on education / qualifications / experience

Time Appointment Category : 75%-100% Appointment (If job description above does not specify appointment or expected weekly hours, assume a 100% appointment.)

Position Type : Civil-Service & Non-Faculty Labor Represented Staff

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Coding Specialist • Twin Cities