DUTIES AND RESPONSIBILITIESRevenue Cycle Coding (85%)Responsible for performing coding and documentation audits to ensure compliance and optimal reimbursement.Responsible for identifying billing and charge issues to Int VP Revenue Cycle, along with proposals on how to address them.Identify Payer Coding Denials to work with appropriate stakeholders to reduce denials.Maintain knowledge of CPT code changes and educate accordingly.Validate trends of missed documentation and coding opportunities presenting a professional format for provider education.Work with third party revenue cycle company to identify coding issues/ opportunities and develop remediation plans.Evaluates the results of the periodic coding audits conducted by an outside agency, and partners with the VP of Revenue Cycle, Operations and clinical services leadership to provide training and feedback to the clinical providers on their performance and areas for improvement.Based on coding and documentation needs, make EPIC automation and/or EPIC hard and soft stops and smart sets to assist with accurate and timely coding.Various projects as assigned.Training and Education (15%)Develop on-going education for current providers and education on-boarding of new providers.Responsible for identification of training needs for all registration areas and provide training material working in conjunction with Regional Director of Operations.Responsible to keep abreast and maintain CMS billing rules and regulations to identify potential billing policy challenges.Remain current on payer billing requirements.CORE COMPETENCIESA demonstrated commitment to PPGNY's mission related to bodily autonomy, health equity, gender and racial justice.A demonstrated commitment to learning about and enhancing practices related to racial equity and its impact on healthcare systems.Strong relationship building skills, including an ability to work and build trust across cultural differences related to race, age, gender, gender identity and expression, sexual orientation, religion, ethnicity, national origin or ability; and to reflect on one's personal identity with humility.Customer service and interpersonal skills and the ability to coordinate work with others, both internally and externally, engages in mutual problem solving.REQUIRED SKILLS/ABILITIESKnowledge of Third-party payer contracts and Medicaid reimbursementCPT4 ICD-10 coding requirements and compliance and all other carrier guidelines; strong knowledge of New York State Medicaid rules.Ability to learn data and analytics techniques to ensure good decision making, performance measurement and financial analysis.Strong time management skills, including the ability to work in a high distraction environment and to juggle multiple deliverables at one time.Excellent interpersonal, written and verbal skills and the ability to explain complex coding regulations to individuals who are not subject matter experts.Strong team building skills.Proficient with Microsoft Office Suite, including Excel skills, such as macros, pivot table and vlook up options.Demonstrated ability to learn new systems.Process improvement orientation.Proven ability to remain focused and calm in stressful situations.REQUIRED QUALIFICATIONSMinimum Education and Work Experience High school diploma/GED.Five plus years experience in outpatient provider coding, including coder certification.Five plus years experience in compliant provider documentation.Three plus years experience in healthcare billing.PPGNY Medical Record Coding Auditor JD 02.26Three plus years experience in EPIC EMR coding, billing and provider documentation.Strong knowledge and utilization of Microsoft Windows, Excel, Word, Power Point and Outlook.PREFERED QUALIFICATIONSAssociate's degree in business.Strong CMS Compliance knowledge and audit guidelinesTYPICAL PHYSICAL DEMANDSRequires prolonged sitting and repetitive tasks including use of a computer. Periodic standing, walking, bending. Requires lifting or moving of up to 15 pounds. Visual acuity sufficient to perform frequent work on a computer screen and review printed reports and other materials. Requires the ability to hear and to communicate orally with others. This role routinely uses standard office equipment such as computers, phones, photocopiers, and filing cabinets, and will require reaching, grasping, pushing, and pulling.TYPICAL WORKING CONDITIONSThis job operates in a professional office environment. Potential exposure to communicable diseases and other conditions in a health center environment. Requires flexible schedule and during some hours, including occasional evenings.TYPICAL SALARY RANGE38.46 - 42.56 an hourThis salary range listed is based on the New York market. Compensation may vary depending on job-related factors and geographic location in accordance with our location-based compensation practices.BENEFITSGenerous PTO and holiday scheduleMedical, dental and vision coverage options for you and eligible dependentsFSA, HSA, Commuter pre-tax reimbursement fundsShort- and Long-Term Disability, Free Basic Life and AD&D401(k) Retirement Plan with Safe Harbor contributions after 1 year of employmentALL POSITIONS REQUIREProof of immunization or immunity to certain communicable diseases (including influenza during the flu season and Covid-19) and testing for tuberculosis. These certifications are required by the NYC DOHMH Health Code, NYSDOH and OSHA.PPGNY is committed to diversity, equity, and inclusion. We believe we are most impactful when people with a wide range of backgrounds, experiences, and identities come together with common purpose. We encourage candidates from all backgrounds to apply.PPGNY is committed to diversity, equity, and inclusion. We believe we are most impactful when people with a wide range of backgrounds, experiences, and identities come together with common purpose. We encourage candidates from all backgrounds to apply.
