Coding Compliance and Training Specialist

Weill Cornell Medicine; North Bergen (NJ); On-site; USD 50,000 - 80,000; Full time

Job summary

An established industry player is seeking a detail-oriented coding specialist to ensure accurate billing and compliance with regulations. This role involves reviewing medical records, managing coding audits, and providing education to staff and physicians. The ideal candidate will have a strong background in multi-specialty billing and a Certified Professional Coder Certificate. Join a dynamic team dedicated to enhancing patient care through precise coding practices and contribute to the financial health of the organization. If you thrive in a fast-paced environment and possess excellent communication skills, this opportunity is perfect for you.

Qualifications

• Minimum 3 years of experience in multi-specialty practice billing.
• Knowledge of third-party insurance billing policies required.

Responsibilities

• Review medical records for coding accuracy and compliance.
• Educate staff and physicians on billing regulations and procedures.

Skills

Multi-tasking

Strong communication skills

Interpersonal skills

Problem-solving

Education

High school diploma or GED

Tools

EPIC

AAPC coding standards

Job description

Position Summary

Performs coding activities and is responsible for reviewing medical records for appropriateness of documentation, procedure, diagnosis codes and evaluation and management codes. Performs charge entry and provides information and direction to the physician relevant to coding. Acts as the CPRC expert reviewing outgoing claims to ensure maximum reimbursement.

Job Responsibilities

• Performs duties in a highly organized, efficient and reliable manner to ensure that all approved charges are reviewed for billing within appropriate timeframes. Reviews appropriate EPIC work queues to ensure claims are being coded appropriately.
• Performs coding and documentation review prior to charge entry for physician services. Reviews medical record and super-bill documentation for completeness and accuracy to support billed services.
• Reviews medical record documentation and charge forms to confirm accuracy of CPT, ICD10 and modifiers selected by the physician performing evaluation and management, procedures, surgery and other services in accordance with compliance policies.
• Conducts all job-related activities in a highly confidential manner and in accordance with the Health Insurance Portability and Accountability Act (HIPAA). Conducts periodic coding audits through AAPC root cause analysis.
• Directs staff on revisions needed to encounter forms due to changes in procedures, diagnosis codes or coding. Oversees requests for new codes to be added to form. Remains current on coding changes in legislative & payer requirements affecting reimbursement.
• Manages research billing activities and accurately executes research billing policies and procedures. Reviews HRBAF and ensures that standard of care and research visits are billed appropriately.
• Identifies denial trends as related to coding errors and works to reduce claim edits and denials. Identifies compliant coding opportunities to increase revenue.
• Ensures reviews are conducted in accordance with Centers for Medicare and Medicaid Services (CMS), and other third party payers reimbursement and coding regulations. Submits recommended coding changes for approval by physicians.
• Keeps abreast of professional billing rules and regulations and uses this knowledge in prospective coding reviews of physician charts to ensure the documentation supports the services billed and all documentation standards are met.
• Recommends appropriate coding corrections to improve compliance based on these results. Performs charge entry activities on a daily basis. Utilizes the appropriate billing document to create a charge in the system.
• Assigns the appropriate financial class to each invoice based on department policies and guidelines. Resolves charge review work queue edits relating to coding. Reviews missing charge reports to assure all charges are captured timely.
• Educates physicians and staff in CMS and other carrier regulations. Provides educational direction to physicians, administrators, support staff and personnel. Provides regular feedback to physicians and support staff to improve success and reduce errors.
• Participates in annual compliance training. Fulfills CEUs to maintain certification status. Maintains knowledge and compliance to all health care laws, regulations and policy changes. Reports deviations from institutional and/or departmental procedures.
• Assists with special projects as needed.

Education

• High school diploma or GED

Experience

Minimum of 3 years related work experience (preferable multi-specialty practice). Comprehensive knowledge of third party insurance billing policies and procedures. Previous billing experience.

Knowledge, Skills and Abilities

• Demonstrated ability to multi-task and prioritize in a fast-paced environment.
• Demonstrated strong communication and interpersonal skills; demonstrated ability to interact with multiple constituencies and exercise "people skills".
• Demonstrated ability to meaningfully contribute value as a member of a multi-disciplinary team, supporting coworkers when necessary to ensure a positive patient experience and smooth operations; including reliability and punctuality.
• Ability to make and be accountable for decisions.
• Demonstrated ability to recognize and resolve or refer problems and conflicts.
• Ability to recommend new procedures and participate in their implementation.

Licenses and Certifications

• Certified Professional Coder Certificate (CPC)

Working Conditions/Physical Demands