Full-Time Billing & Coding Compliance Analyst

JOB SUMMARY: Under general direction of the Assistant VP, Revenue Cycle Management, this position is responsible for the identification, review, investigation and resolution of billing and coding questions and issues. This position is also responsible for chart auditing, report composition and reporting that clearly outline key performance indicators and provide educational feedback to those providers/ coding / billing service areas who are not in compliance with regulated billing and coding practices.

The role of this position is to provide billing/coding compliance guidance via research and analysis of various coding and medical billing regulations as it pertains to proper reimbursement of claims. You will also be providing assistance to providers, coders and billing staff after account reviews are conducted or billing/coding compliance issues are identified in accordance with CMS billing guidelines.

REQUIRED EDUCATION and/or EXPERIENCE:

• High school diploma or GED required
• Minimum of five (5) year experience in third party collections preferred
• Minimum of five (5) year aged claims / denials management experience preferred.
• Minimum of five (5) years ICD-10, CPT and HCPCS coding knowledge preferred
• Experience with NextGen, Cerner, eClinical Works, RPMS and clearinghouse experience such as Change Healthcare, ClaimRemedi, Office Ally, and Avality preferred.
• Quality Assurance audits on proper CPT/HCPCS modifier utilization
• CMS regulatory updates and other notifications (i.e. Med Learn Matters Articles)
• OIG and physician billing compliance work plan items
• Private Sector reimbursement audits
• ABN compliance - Delivery, completion and appropriate modifiers applied in patient accounting system.
• Charge capture and validation (clinic and procedural)
• Reimbursement validation
• Clinical Research billing validation – Ensuring that claims submitted to Medicare have the appropriate modifiers appended.
• Telehealth – Ensuring that documentation supports service and is in accordance with CMS telehealth guidelines.
• Patient account audits for proper reimbursement
• Posting Audits – Ensuring that accounts are posted properly
• Collaborating with external department members to seek the best practice/resolution based on CMS guidance.
• Collaborating with the creation of educational and training tools

Knowledge, Skills & Abilities:

• Ability to perform effective research and prepare documents utilizing Microsoft Excel / MS Word
• Detail oriented.
• Excellent organizational skills.
• Good verbal and written communication skills.
• Ability to work independently and as part of a team.
• Ability to coordinate a varying workload and be flexible towards changing priorities.
• Ability to apply knowledge and make decisions quickly and accurately.
• Strong computer skills to include Microsoft Word and proficiency with Excel and Power Point.

Job Type: Full-time

Benefits:

• 401(k)
• Dental insurance
• Flexible schedule
• Flexible spending account
• Health insurance
• Paid time off
• Vision insurance

Schedule:

• Monday to Friday

Application Question(s):

• Must have remote experience with multi-computer screen work environment.
• Do have current coding credential and experience, and are you willing to achieve your CPMA license?

Education:

• High school or equivalent (Required)

Experience:

• Medical Billing / Accounts Receivable: 2 years (Required)
• Medical Billing Software: 5 years (Required)
• ICD-10, CPT and HCPCS coding knowledge: 5 years (Required)
• Remote Work: 2 years (Required)

License/Certification:

• Medical Billing /Coding Course (e.g. CPB or CPC) (Required)

Work Location: Remote