Prof Coding & Billing Auditor

About Us

We're Maimonides Health, Brooklyn's largest healthcare system, serving over 250,000 patients each year through the system's 3 hospitals, 1800 physicians and healthcare professionals, more than 80 community-based practices and outpatient centers. At Maimonides Health, our core values H.E.A.R.T drives everything we do. We uphold and maintain Honesty, Empathy, Accountability, Respect, and Teamwork to empower our talented team, engage our respective communities and adhere to Planetree's philosophy of patient-centered care. The system is anchored by Maimonides Medical Center, one of the nation's largest independent teaching hospitals and home to centers of excellence in numerous specialties; Maimonides Midwood Community Hospital (formerly New York Community Hospital), a 130-bed adult medical-surgical hospital; and Maimonides Children's Hospital, Brooklyn's only children's hospital and only pediatric trauma center. Maimonides' clinical programs rank among the best in the country for patient outcomes, including its Heart and Vascular Institute, Neuroscience Institute, Boneand Joint Center, and Cancer Center. Maimonides is an affiliate of Northwell Health and a major clinical training site for SUNY Downstate College of Medicine.

Overview

Ensures the accuracy of data submitted to governmental and commercial payers and to governmental reporting agencies. Conducts routine and scheduled audits of data reported by all Professional Coding Specialists I and II, and Professional Billing Specialists I and II.

Responsibilities

• Thoroughly knowledgeable and experienced in all aspects of the duties performed by the Professional Coding Specialists I and II, and the Professional Billing Specialist I and II, in order to provide guidance to improve accuracy and efficiency of the team
• Utilizes significant coding and billing experience to review the work of others and identify billing and coding issues that compromise the integrity of the data submitted by Maimonides Medical Center for reimbursement purposes. Identifies over and under payments that the Medical Center has claimed and ensures those encounters are rebilled as corrected claims to the appropriate payers
• Provides feedback directly to the team of coding and billing specialists and, in collaboration with Compliance, to physicians. In conjunction with Department leadership, identifies training needs and educational opportunities that may benefit the coding and billing specialists and improve the integrity of data
• At least annually, creates an audit plan to review issues directly related to the cause(s) of denials. Additional reviews will be conducted of randomly selected work products and those at a statistically significant volume of cases. Reviews will include, but not be limited to, assessing coding of E&M, diagnoses, and procedures along with modifiers, sequencing of diagnostic and procedural coding, changes captured, and accuracy of data entry
• Coaches coding and billing specialists on proper and compliant appeal preparation. May prepare appeals as needed
• Researches coding and billing related rules and educates coding and billing specialists on same. Shares articles from professional journals on coding and billing related topics
• May be assigned to one or more physicians who need coaching on their assignment of codes. Communicates daily with the physician on recommended code changes. Reports progress to the Department Director or Manager and the Compliance Department liaison
• Creates or maintains policy and procedures for all areas of job responsibilities
• Complies with established organization and departmental policies and procedures, quality assurance program, compliance program, privacy and security, safety, environmental, and infection control measures
• In the absence of the manager, supervises the activities of the department

Qualifications

Education:

High School Diploma or Equivalent required; 1-2 years of college preferred.

Completed billing course with certification required, such as AAPC's Certified Professional Biller (CPBtm) or American Medical Billing Association's Certified Medical Reimbursement Specialist (CRMS).

Successful completion of a coding program ICF-10-CM, CPT-4 recognized by the American Health Information Management Association and/or American Academy of Professional Coders. CPC, COC, or CCS/CCS-P required.

Experience:

Comprehensive knowledge of ICD-10-CM, HCPCS, and CPT-4 classification systems, Medical Terminology, Anatomy and Physiology.

Demonstrated skill in coding conventions.

Minimum of 5 years of prior professional clinical coding experience required; a minimum of 3 years billing experience preferred. Must pass Coding Competency Test.

The above experience must include 3 years of experience at the Medical Center working in the Professional Outpatient Coding Department or in a comparable coding and billing role with demonstrated achievement of quality and quantity requirements.

Auditing experience highly preferred.

Skills:

Strong and accurate keyboard skills. Must pass basic data entry skills test.

Encoder and CAC experience.

Spreadsheet/word processing experience.

Works well in an environment with firm deadlines; results oriented.

Performs multiple tasks effectively.

Demonstrated familiarity with navigating billing systems.

Familiarity with third part billing policies and procedures including Medicare/Medicaid, Managed Care, No-Fault and Workers' Compensation required.

Appeal and/or denial management experience required.

Effectively uses e-mail.

Excellent oral and written communication skills.

Good interpersonal skills.

Speaks, reads and writes English to the extent required by the position.

Pay Range

USD $68,000.00 - USD $90,000.00 /Yr.

Equal Employment Opportunity Employer

Maimonides Medical Center (MMC) is an equal opportunity employer.