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JOB PURPOSE:

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. It involves acting as a liaison between coding operations and clinical staff, training and coaching medical personnel on coding guidelines, and ensuring the accuracy and timeliness of clinical documentation. Additionally, the role includes analyzing and optimizing diagnosis data submission processes, presenting performance results to leadership, and supporting HCC/RAF optimization strategies. The role will also oversee the training of Medical Practice Assistants, Physician and IDT disciplines in ICD-9/ICD-10 guidelines.

JOB RESPONSIBILITIES:

+ Responsible to 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.

+ Research and perform changes and additions to procedure master, fee schedules, diagnosis tables and modifier tables to ensure accurate reporting of procedures.

+ Acts as liaison between medical coding/revenue cycle operations and the clinical physicians/staff.

+ Assist 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.

+ Works with Site Medical Director/Attending Physician and Nursing in QA review of their respective disciplines as they relate to the Practice’s overall activities.

+ Responsible for ensuring that all services /disciplines in the Practice provide coordinated care and excellent communication with all disciplines at CenterLight Healthcare in a timely manner.

+ 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.

+ Present HCC/RAF performance results and findings regularly to key internal leadership.

+ Propose opportunities to maximize reimbursement based on CMS- HCC Model and Methodology.

+ Make recommendations to clinical staff as to how to best support the HCC/RAF optimization strategies.

+ Monitor individual physician and clinic performance for key HCCs and diagnoses, provide 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.

+ Perform random audits of coding submissions by outside vendors.

+ Other duties as assigned.

Schedule: 8:30AM – 5:30PM

Weekly Hours: 40

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):

1. Certified Professional Coder (CPC)

2. Certified Professional Medical Auditor (CPMA)

3. Certified Professional Practice Manager (CPPM)

4. Certified Professional Biller (CPB)

5. 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.

+ Attention to detail, critical thinking, time management skills, a sense of urgency.

+ Strong interpersonal and communication skills with the ability to work collaboratively across departments.

+ Knowledge of Healthcare regulations (i.e.- HIPAA, CMS, etc.) and a commitment to patient data privacy and security.

+ Experience with EMR software, i.e. Athena and provider portal application, i.e. Stellar Health, is strongly preferred.

+ Proficiency with Microsoft Office Suite (Excel, Word, PowerPoint), especially Excel is required.

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. In addition, they must be able to speak comfortably and clearly with language motor skills for customers to understand the individual.

+ Cognitive Ability – Must be able to demonstrate good decision-making, reasonableness, cognitive ability, rational processing, and analysis to satisfy essential functions of the job.

Disclaimer: Responsibilities and tasks outlined in this job description are not exhaustive and may change as determined by the needs of the company.

We are an affirmative action and equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, disability, age, sexual orientation, gender identity, national origin, veteran status, height, weight, or genetic information. We are committed to providing access, equal opportunity, and reasonable accommodation for individuals with disabilities in employment, its services, programs, and activities.

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