Medical Coding and Billing Assistant 1

Yale Cancer Center; New Haven, Northern (CT, KY); Hybrid; USD 65,000 - 75,000; Full time

Job summary

Yale Medicine in New Haven is seeking a Coding and Billing Assistant 1 to review clinical documentation for accurate ICD-10 and CPT/HCPCS codes and modifiers. You will ensure submissions comply with YMA policies, payer guidelines, and HIPAA requirements, delivering timely billing for professional charges.

Under the supervision of Yale Medicine Administration (YMA), you will work with Epic and other EHR systems, perform quality assurance, and participate in team training to maintain high

Qualifications

• Proficiency in ICD-10, CPT/HCPCS coding guidelines.
• Experience with electronic health records and practice applications.
• Knowledge of Federal payer regulations and HIPAA requirements.

Responsibilities

• Review charge submissions for accuracy and compliance.
• Verify information for clean claims submission.
• Escalate questions and resolve issues per guidelines.

Skills

ICD-10/CPT coding

EHR systems

HIPAA compliance

communication skills

fast-paced productivity

Education

High school diploma or equivalent

Associate’s degree

CPC-A certification

Tools

Epic

MS Word

Excel

Practice management software

Job description

Working at Yale means contributing to a better tomorrow. Whether you are a current resident of our New Haven-based community, eligible for opportunities through the New Haven Hiring Initiative, or a newcomer, interested in exploring all that Yale has to offer, your talents and contributions are welcome. Discover your opportunities at Yale!

Salary Range

$31.83

Overview

Under the direction of Yale Medicine Administration (YMA) Coding and Billing, the Coding and Billing Assistant 1 is responsible for reviewing all aspects of charge submission for patient clinical services based on coding, documentation review, quality assurance, and compliance guidelines. Reviews charge submissions for compliance with established coding guidelines, all YMA policies and protocols, third party reimbursement policies, Federal payer regulations, and HIPAA guidelines. Performs effective workflow processes to file complete, accurate and timely billing of professional charges, while maintaining productivity to meet lag day expectations. May review and analyze documented medical services to verify accurate documentation and coding of services performed.

Required Skills and Abilities

• 1. General/intermediate knowledge of ICD-10, CPT, HCPCs and modifier coding, medical terminology, human anatomy, and digital coding resources and software. Ability to analyze and interpret evaluation and management documentation guidelines as well as procedures and applicable coding guidelines.
• 2. Demonstrated ability with an electronic health record and practice application systems, electronic data entry, and web-based applications and websites. Intermediate proficiency with MS Word, Excel, Outlook (emails and calendars).
• 3. Demonstrated knowledge of Federal payer regulations, third party payers, HIPAA rules, reimbursement policies and procedures. Proven ability to interpret and apply guidelines.
• 4. Demonstrated strong interpersonal, verbal and written communication skills. Ability to effectively communicate with team members to resolve questions regarding collaboration and assignments. Communicate effectively with providers, following escalation processes with analytics team and manager.
• 5. Demonstrated ability to work independently; organize and prioritize own work with minimal supervision; ability to work in a fast-paced environment meeting timely deadlines while maintaining productivity and quality standards. Ability to work effectively as a team member with common goals.

Preferred Education, Experience and Skills

• 1. Previous Epic experience; experience within an academic medical environment or large multi-specialty practice; CPC certification preferred.

Principal Responsibilities

• 1. Performs work queue resolution of medical billing charge sessions by reviewing clinical documentation to confirm diagnostic (ICD-10) and procedural (CPT/HCPCS) codes and modifiers, based on charge review edits for Yale Medicine patient clinical services filed to charge review work queues. May perform manual charge entry for non-Epic services. With an ability to navigate within the Professional Billing applications, ensures that all charge review edits are appropriately resolved in charge review work queues utilizing claim judgement and critical thinking skills. Draws valid conclusions to support decisions.
• 2. May verify all information required to submit a clean claim including provider, place of service, date of service, bill area, all codes and special billing procedures that may be defined by a payer, contract or YMA. Ensures compliance with Teaching Physician guidelines within an academic medical practice.
• 3. Pends charge sessions to seek corrective action for services not meeting documentation requirements in accordance with YMA policies and procedures. May identify that a provider should be contacted to clarify or amend a medical record, following communication and escalation procedures. May modify clinician’s selection.
• 4. Adheres to YMA policies and procedures and Yale Medicine’s Mission, Values and Guiding Principles. Actively participates in team and department training and education programs and staff meetings. Establishes and cultivates productive relationships among staff to support a positive team environment and professional interactions. Maintains professional and technical knowledge by participating in educational workshops and reviewing professional publications.
• 5. May perform other duties as assigned.

Required Education and Experience

Four years of related work experience, two of them in the same job family at the next lower level, and high school level education; or two years of related work experience and an Associate’s degree, or an equivalent combination of experience and education.

Required License(s) or Certification(s)

Certified Professional Coder Apprentice (CPC-A) through AAPC organization. Must maintain certification through annual education requirements and achieve CPC status within 2 years.

Preferred Licenses or Certifications

Certified Professional Coder (CPC)

Physical Requirements

Ability to push, pull, and lift in excess of 20 pounds as well as travel around the medical school campus.

Compensation Grade

Labor Grade D

Time Type

Full time

Duration Type

Staff

Work Model

Remote

Location

221 Whitney Ave, New Haven, Connecticut

Background Check Requirements

All candidates for employment will be subject to pre-employment background screening for this position, which may include motor vehicle, DOT certification, drug testing and credit checks basedon the position description and job requirements. All offers are contingent upon the successful completion of the background check. For additional information on the background check requirements and process visit "Learn about background checks" under the Applicant Support Resources section of Careers on the It's Your Yale website.

Health Requirements

Certain positions have associated health requirements based on specific job responsibilities. These may include vaccinations, tests, or examinations, as required by law, regulation, or university policy.

Posting Disclaimer

University policy is committed to affirmative action under law in employment of women, minority group members, individuals with disabilities, and protected veterans. Additionally, in accordance with Yale's Policy Against Discrimination and Harassment, and as delineated by federal and Connecticut law, Yale does not discriminate in admissions, educational programs, or employment against any individual on account of that individual's sex, sexual orientation, gender identity or expression, race, color, national or ethnic origin, religion, age, disability, status as a special disabled veteran, veteran of the Vietnam era or other covered veteran.

Inquiries concerning Yale's Policy Against Discrimination and Harassment may be referred to the Office of Institutional Equity and Accessibility (OIEA).

Note

Yale University is a tobacco-free campus.