Job Description

Coding Compliance and Training Specialist

Title: Coding Compliance and Training Specialist

Location: Midtown

Org Unit: Coding Administration

Work Days: Monday-Friday

Weekly Hours: 35.00

Exemption Status: Non-Exempt

Salary Range: $36.81 - $43.70

*As required under NYC Human Rights Law Int 1208-2018 - Salary range for this role when Hired for NYC Offices

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. Oversee 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. Utilize the appropriate billing document to create a charge in system.
• Assigns the appropriate financial class to each invoice based on department policies and guidelines. Resolves charge review work queue edits relating to coding. Review 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 year 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

Cornell welcomes students, faculty, and staff with diverse backgrounds from across the globe to pursue world-class education and career opportunities, to further the founding principle of “... any person ... any study.” No person shall be denied employment on the basis of any legally protected status or subjected to prohibited discrimination involving, but not limited to, such factors as race, ethnic or national origin, citizenship and immigration status, color, sex, pregnancy or pregnancy-related conditions, age, creed, religion, actual or perceived disability (including persons associated with such a person), arrest and/or conviction record, military or veteran status, sexual orientation, gender expression and/or identity, an individual’s genetic information, domestic violence victim status, familial status, marital status, or any other characteristic protected by applicable federal, state, or local law.

Cornell University embraces diversity in its workforce and seeks job candidates who will contribute to a climate that supports students, faculty, and staff of all identities and backgrounds. We hire based on merit, and encourage people from historically underrepresented and/or marginalized identities to apply. Consistent with federal law, Cornell engages in affirmative action in employment for qualified protected veterans as defined in the Vietnam Era Veterans’ Readjustment Assistance Act (VEVRRA) and qualified individuals with disabilities under Section 503 of the Rehabilitation Act. We also recognize a lawful preference in employment practices for Native Americans living on or near Indian reservations in accordance with applicable law.

Job Tags

Similar Jobs