Affirmative Action, Analysis Skills, Best Practices, Billing, Certified Coding Specialist (CCS), Certified Professional Coder (CPC), Code Reviews, Conferences, Corrective Action, Database Analysis, Demographics, Diversity, Documentation, Documentation Standards, Federal Laws and Regulations, Financial Reporting, Genetics, High School Diploma, Insurance, Leadership, Legal, Maintain Compliance, Medical Coding, Medical Records, Military, Outpatient Care, Patient Care, Payment Posting, Performance Analysis, Physical Demands, Problem Solving Skills, Regulations, Regulatory Compliance, Rehabilitation Act, Reimbursement, Spreadsheets, State Laws and Regulations, Support Documentation, Third-Party Payer
Title: Medical Coding Specialist Lead
Location: Midtown
Org Unit: Administration
Work Days:
Weekly Hours: 35.00
Exemption Status: Exempt
Salary Range: $78,100.00 - $84,500.00
- As required under NYC Human Rights Law Int 1208-2018 - Salary range for this role when Hired for NYC Offices
Position Summary
Under supervision, assists in the development and evolution of the overall strategy for the departments coding operations This role is also responsible for reviewing medical records for compliance with coding and documentation requirements
Job Responsibilities
- Composes and maintains billing and/or billing compliance associated correspondence. Determines proper account resolution and/or adjustment as needed.
- Performs charge entry and/or payment posting within the practice management billing system as needed. Tracks and resolves issues on denied claims. Resubmits or appeals claims as required. Escalates more complex claim issues when necessary.
- Attends workshops, seminars and/or conferences to keep abreast of standards and best practices within the field. Disseminates information to colleagues and/or staff as appropriate.
- Analyzes coding activities and recommends systemic changes. Facilitates approved changes.
- Meets regularly with clinical faculty and leadership to review compliance audit results, to ensure compliance with internal and external policies and regulations.
- Conducts prospective coding reviews of outpatient, inpatient and procedure documentation to ensure that the documentation supports the services billed and all documentation standards are met.
- Reviews findings of chart reviews with individual providers and recommends appropriate coding corrections.
- Addresses and resolves coding errors.
- Educates providers about coding changes and new compliance policies and regulations.
- Updates demographics and insurance information within the practice management system.
- Verifies eligibility prior to claim submission.
- Tracks compliance errors.
- Actively monitors employee performance and escalates issues or concerns.
- Develops routine and ad hoc reports, spreadsheets and databases analyzing and summarizing billing information.
- Ensures compliance with regulatory audits/inspections and/or internal reviews. Develops and recommends corrective action plans to address deficiencies identified. May serve as liaison to audit team(s) during on-site visits.
Education
Experience
Approximately 3 years of experience in physician billing and coding
Knowledge, Skills and Abilities
- Prior experience working with an eMR system.
- Working knowledge of federal and state reimbursement regulations.
- Knowledge of third party insurance billing policies and procedures.
Licenses and Certifications
- Certified coder (CPC, CCS-P)
Working Conditions/Physical Demands
Standard office work
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