Coding Specialist, Part Time (Athena Experience Preferred)

VNS Health; New York (NY); On-site; USD 66,000 - 72,000; Full time

Benefits offered by this job

Referral bonus

Generous PTO

Health insurance

401k match

Wellness programs

FSAs

Tuition reimbursement

Professional growth

Job summary

VNS Health in New York is seeking a claims review professional to audit billing, coding, and service documentation for compliance and reimbursement. The role focuses on applying ICD-10-CM, HCPCS, and CPT-4 coding, and providing actionable recommendations to improve accuracy.

You will train staff, support quality metrics, and ensure adherence to CMS guidelines and risk adjustment methodologies while collaborating with clinical and revenue teams.

Qualifications

• Bachelor's degree or equivalent work experience required.
• Three+ years of payor work experience with medical records.
• CPC/CCS/CRC preferred; AHIMA/AAPC cert preferred.
• Strong knowledge of claims submission procedures and CMS regulations.

Responsibilities

• Reviews medical claims, records and other information for billing, coding and compliance issues; makes coding recommendations.
• Reviews documentation to ensure key quality metrics are noted on claims; performs chart reviews.
• Conducts independent coding reviews to assign ICD-10-CM, HCPCS and CPT codes according to CMS guidelines.
• Generates reports and provides guidance on coding grids and audit results.
• Engages with providers and staff to educate on best practices and regulatory changes.

Skills

Billing compliance knowledge

Medical coding expertise

CMS guidelines familiarity

Attention to detail

Communication skills

Education

Bachelor's Degree or equivalent

Tools

Microsoft Office

Medical record systems

Job description

Overview

Reviews and audits claims for billing, coding, services and other compliance or reimbursement issues. Assists with non-clinical aspects of the claims review process and acts as a coding resource. Provides training and support to Medical Care at Home Clinicians and staff to provide best practices of claims coding. Applies coding skills to various initiatives to ensure compliance in claims submissions. Works under moderate supervision.

What We Provide

• Referral bonus opportunities
• Generous paid time off (PTO), starting at 30 days of paid time off and 9 company holidays
• Health insurance plan for you and your loved ones, Medical, Dental, Vision, Life and Disability
• Employer-matched 401k retirement saving program and opportunity for both pre- and post-tax contributions
• Personal and financial wellness programs
• Pre-tax flexible spending accounts (FSAs) for healthcare and dependent careand commuter transit program
• Generous tuition reimbursement for qualifying degrees
• Opportunities for professional growth, career advancementand CEU credits

What You Will Do

• Reviews medical claims, records and other requested information for billing, coding and other compliance or reimbursement related issues; makes coding and documentation recommendations for adherence to risk adjustment models.
• Reviews medical documentation to ensure all key quality metrics are noted on claim, as provided during the encounter. Performs medical chart reviews to validate codes for quality monitoring, reporting, and analysis.
• Conducts coding reviews independently on all provider documentation to assign the correct ICD-10 codes and ensure all documentation is accurate, precise, and adherent to CMS guidelines pertinent to Risk Adjustment Hierarchical Condition Category (HCC) methodology.
• Assigns appropriate ICD10-CD, HCPCS and CPT codes as well as other codes necessary to process claims based on claim information submitted.
• Utilizes administrative policies, regulatory codes, legislative directives, and guidelines to inform decisions and appropriate coding.
• Maintains coding grids for MCAH services with the assistance of management and provides guidance on use of grids.
• Works with Clinical Director in preparing internal presentations, knowledge libraries, coding guidelines, and summary reports of coding review for department infrastructure, maintains professional communication with provider engagement team by assisting with analysis, trending, and presentation of audit/review findings, outcomes, and issues.
• Engages with medical practitioners to provide feedback and educational resources on best practices for medical coding and keeps current on new coding and billing guidelines, federal and state initiatives regarding claims and trains other staff in new/changes to regulations.
• Communicates and follows up with a variety of internal and external sources including but not limited to providers, members, attorneys, regulatory agencies and other carriers on any claim related matters.
• Generates routine reports for managing process time frames and vendor productivity.
• Performs insurance eligibility checks and authorization prior to for care being provided. Communicates with clinicians as needed.
• Coordinates recoupment efforts with the Practice Manager and Revenue Cycle and Finance Departments that are the result of billing errors. Responds to inquiries regarding recoupment.
• Review coding disputes, which includes review of all supporting documentation. Recommend payment based on review and prepare response to appeal.
• Participates in special projects and performs other duties as assigned.

Qualifications

Licenses and Certifications

• Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) or (CRC) Certified Risk Adjustment Coder in ICD-10-CM coding required. preferred
• Active Certified Coder Certification through AHIMA or AAPC required preferred

Education

• Bachelor's Degree or equivalent work experience required

Work Experience

• Minimum three years of payor work experience with medical records, including ICD-10-CM or current coding system and medical record systems required
• Strong knowledge of claims submission procedures and systems, State, Federal and Medicare Regulations required
• Knowledge of medical terminology, physiology, pharmacology, and disease processes and related procedures required
• Working knowledge of medical terminology, provider reimbursement, ICD-10, HCPCS and CPT-4 coding required
• Must be PC literate and possess a strong understanding of Microsoft applications required
• Ability to handle multiple priorities and meet deadlines required

Pay Range

USD $66,300.00 - USD $72,000.00 /Yr.

About Us

VNS Health has been committed to meeting the needs of New Yorkers for over 130 years. We're one of the largest nonprofit home- and community-based health care organizations in the country, and today, more than 11,500 team members work together to make a difference in the lives of more than 99,000 patients and members on any given day.