Revenue Cycle Specialist-Revenue Integrity - Pathology

Position Summary

Remote position - Join a team of dedicated revenue cycle professionals in the Central Business Office (CBO) of Weill Cornell Medicine (WCM). Apply your knowledge as a Certified Professional Coder (CPC) to investigate and resolve coding related insurance payment denials. Review medical records to write robust appeals defending medical necessity. The CBO partners with WCM Clinical Departments to increase and expedite service revenue, reduce aged AR, and trend denials for their root causes thereby driving efficiencies, to include clinical documentation improvement and coding denials prevention.

Job Responsibilities

• Performs retrospective coding review of denied charges for physician services.
• Reviews medical records for completeness and accuracy to ensure documentation supports the services billed and all documentation standards are met for billing.
• Makes corrections to charges when necessary to match the CPT and or Diagnosis codes to the documentation as appropriate.
• Analyzes for invalid denial trends, payer specific carrier submission requirements & system optimization.
• Performs extensive follow-up to investigate and resolve payment denial trends.
• Resolves outstanding accounts utilizing ancillary applications and websites as tools to retrieve medical documentation, claim status and billing guidelines to substantiate corrected claim submissions, written appeals, coding and medical necessity reviews.
• Researches and interprets payer contract terms and compiles necessary supporting documentation templates for appeals according to various payer claim guidelines.
• Ensures denial reviews are conducted in a timely manner.
• Maintains up-to-date policies and procedures and knowledge related to managed care and third party payors.
• Participates in annual and on-going mandatory compliance training.
• Fulfills Continuing Education Units necessary to maintain certification status.
• Affords assistance in training current and new employees on the use of systems and departmental policies and procedures.
• Performs other related duties as assigned.

Education

• High school diploma or GED in related field
• Certification as a Certified Professional Coder (CPC) or Certified Coding Specialist (CCS). Should be certified by AHIMA or AAPC.
• Approximately 3-5 years of physician billing experience, specifically accounts receivable and collection experience.
• Prior experience working with an eMR system.
• Knowledge of medical terminology.
• Knowledge of third-party reimbursement.
• Microsoft Excel and other reporting software to sort, filter, summarize, and identify various accounts receivable trends.
• Pathology experience preferred.

Experience

• Experience in physician billing, specifically accounts receivable and collection experience.
• Prior experience working with an eMR system.

Knowledge, Skills and Abilities

• Proficient in CPT and ICD10 CM coding guidelines.
• Ability to meet productivity standards and identify any issues or trends and bring them to the attention of management.
• Demonstrated ability to function independently and exercise independent judgment.
• Demonstrated critical thinking and analytical skills.
• Ability to meet daily coding and denial management production requirements along with quality as per Company norms.
• Strong computer skills in data entry, coding, knowledge of Electronic Medical Record software (Epic), Microsoft Office, Excel.
• Ability to follow coding guidelines and legal requirements to ensure compliance with our Institutional, federal, and state regulations.
• Excellent interpersonal, verbal and communication skills.

Licenses and Certifications

• Certified Professional Coder Certificate (CPC) or Certified Coding Specialist (CCS).

Working Conditions/Physical Demands

• Remote based work with rare onsite requirement.
• Dedicated workspace conducive to a healthy work environment.