MEDICAL CODING AND BILLING ANALYST

About the role

Responsible for supervising, evaluating, and consistently improving the day-to-day operations of Medical Practice. This role is responsible for accurate and timely billing of insurance claims and patient statements across multiple sites, implements accurate medical coding policies, and enhances operational processes.

Responsibilities

• Deliver accurate and timely billing of insurance claims and patient statements for all Sites (12 sites around NYC) as well as other entities within the organization.
• Review coding and billing process for operational enhancements.
• Responsible for reviewing and implementing accurate medical/coding policies and Claims Manager edits across all PACE sites and other entities.
• Acts as liaison between medical coding/revenue cycle operations and the clinical physicians/staff.
• Aid in new hire orientation of Medical Practice and Medical Records staff.
• Train and coach physicians and IDT disciplines regarding Coding policies.
• Establishes and monitors a system for on-site and off-site storage, access and protection of active and discharged medical records.
• Assures accuracy and timeliness of clinical documentation in Medical Records and/or Electronic medical record solution.
• Provides training and performs chart audits for proper documentation and assure accuracy of diagnostic coding medical documentation.
• Determines coding for new and existing patients and acts as a resource for coding and related areas for Center Light Healthcare System.
• Covers for staff and/or finds temporary coverage as needed.
• Attends Medical Practice meetings and arranges own staff meetings on a regular basis.
• Analyze and monitor coding processes to ensure accurate diagnosis data has been submitted to Claims, and CMS.
• Evaluate and enhance the diagnoses data submission process to CMS, proposing innovative approaches to create or improve automation and optimize processes where appropriate.
• Review and analyze monthly financial reports submitted by Medicare related to diagnostic data.
• Presents HCC/RAF performance results and findings regularly to key internal leadership.
• Propose opportunities to maximize reimbursement based on CMS- HCC Model and Methodology.
• Makes recommendations to clinical staff as to how to best support the HCC/RAF optimization strategies.
• Maintains monitoring individual physician and clinic performance for key HCCs and diagnoses, provides leading indicator data and standard reports to the physician practices on current performance.
• Serves as a subject matter expert on Risk Adjustment Data Validation (RADV) audits from Medicare.
• Performs random audits of coding submissions by outside vendors.
• Other duties as assigned.

  Qualifications

  • Education: College degree required. Must have at least one of the following certifications with an active status by the American Association of Professional Coders (AAPC) or American Health Information Management Association (AHIMA): Certified Professional Coder (CPC), Certified Professional Medical Auditor (CPMA), Certified Professional Practice Manager (CPPM), Certified Professional Biller (CPB), Certified Risk Adjustment Coder (CRC).
  • Experience: Three (3) years’ experience in medical coding/medical billing is required. Working knowledge of Medicare and Medicaid is required. Available to travel around all PACE Sites on a regular basis.
  • Physical Requirements: Individuals must be able to sustain certain physical requirements essential to the job. This includes, but is not limited to: Standing – Duration of up to 6 hours a day. Sitting/Stationary positions – Sedentary position in duration of up to 6-8 hours a day for consecutive hours/periods. Lifting/Push/Pull – Up to 50 pounds of equipment, baggage, supplies, and other items used in the scope of the job using OSHA guidelines, etc. Bending/Squatting – Have to be able to safely bend or squat to perform the essential functions under the scope of the job. Stairs/Steps/Walking/Climbing – Must be able to safely maneuver stairs, climb up/down, and walk to access work areas. Agility/Fine Motor Skills - Must demonstrate agility and fine motor skills to operate and activate equipment, devices, instruments, and tools to complete essential job functions (ie. typing, use of supplies, equipment, etc.). Sight/Visual Requirements – Must be able to visually read documentation, papers, orders, signs, etc., and type/write documentation, etc. with accuracy. Audio Hearing and Motor Skills (language) Requirements – Must be able to listen attentively and document information from patients, community members, co-workers, clients, providers, etc., and intake information through audio processing with accuracy. Cognitive Ability – Must be able to demonstrate good decision-making, reasonableness, cognitive ability, rational processing, and analysis to satisfy essential functions of the job.

  Benefits

  Salary Range (Min-Max): $75,000.00 - $85,000.00