Billing Compliance Specialist

Weill Cornell Medicine; New York (NY); On-site; USD 79,000 - 90,000; Full time

Job summary

Weill Cornell Medicine seeks a Billing Compliance Specialist to monitor physician billing activity for compliance and provide audit feedback. You will track audit results, analyze coding patterns, and support staff training to ensure adherence to federal and state regulations while maximizing compliant revenue.

The role requires a CPC certification, a Bachelor's degree, and 2–3 years of relevant billing experience.

Qualifications

• Knowledge of professional billing including physician billing and reimbursement.
• Familiarity with third-party payer processes and carrier relations.

Responsibilities

• Track and analyze audit results; prepare reports.
• Analyze physician coding patterns and documentation using databases.
• Assist in orientation of new staff to billing and compliance policies; notify about training.
• Educate staff on compliant coding to maximize revenue.
• Design audit tools; conduct prospective and retrospective audits; maintain records.
• Research provider coding practices and educate on appropriate coding for specialties.
• Train on coding/documentation changes implemented by internal teams and carriers.
• Monitor effectiveness of corrective action plans and update policies.

Skills

Professional billing

Third-party reimbursement

Education

Bachelor's Degree in related field

Job description

• As required under NYC Human Rights Law Int 1208-2018 - Salary range for this role when Hired for NYC Offices

Title

Billing Compliance Specialist

Location

Midtown

Org Unit

The Office of Compliance

Work Days

Weekly Hours: 35.00

Exemption Status: Exempt

Salary Range: $79,400.00 - $90,200.00

As required under NYC Human Rights Law Int 1208-2018 - Salary range for this role when Hired for NYC Offices

Position Summary

Monitors physician billing activity for compliance and audit feedback processes.

Job Responsibilities

• Tracks and trends results of audits. Prepares and presents reports on results.
• Analyzes physician coding patterns and other documentation utilizing electronic databases.
• Assists in orienting new employees/faculty to departmental billing and compliance policies and procedures and notifies new employees/faculty of upcoming compliance training workshop dates.
• Monitors coding and medical record documentation compliance with federal and state regulations. Educates clinical staff and providers on compliant coding for maximum revenue.
• Designs audit tools and methodology for conducting audits. Conducts prospective and retrospective compliance documentation audits. Maintains integrity of electronic and hard copy files and databases.
• Researches and educates providers on appropriate coding for provider specialty.
• Trains as necessary on coding/documentation changes implemented internally and by insurance carriers.
• Monitors effectiveness of corrective action plans.
• Evaluates current compliance plan, makes recommendations for changes, and implements and executes new policies and procedures.
• 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.
• Identifies trends in revenue cycle activities, including payments, denials, billing, coding and/or documentation errors. Recommends actions plans to address deficiencies. Monitors implementation of corrective action plans.

Education

• Bachelor's Degree in related field

Experience

Approximately 2-3 years of experience in medical records and/or physician billing Approximately 1-2 years of experience as medical coder

Knowledge, Skills and Abilities

• Demonstrated knowledge of professional billing, including physician billing, reimbursement, and carrier relations.
• Demonstrated knowledge of third party reimbursement.

Licenses and Certifications

• Certified Professional Coder Certificate (CPC)

Working Conditions/Physical Demands

Standard office work

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