Job Summary: Under the supervision of the Billing Manager, the primary responsibilities for this position include the following: conducting prospective audits of coding and billing; analyzing physician and provider documentation in outpatient office health records (electronic format) to ensure accurate diagnosis: correcting evaluation and management (E/M) service levels, appropriate procedure codes, and any necessary modifiers. Accesses charge work queues to audit and assign charges accordingly.

While the main responsibility will be auditing this position will also be required to answer patient and internal billing phone calls.

Essential Duties and Responsibilities include the following:

Navigates the patient health record, office visit notes, and procedure reports in the determination of diagnoses, reason for visit, procedures, and modifiers to be coded.

Codes outpatient records utilizing coding books, online tools, and references, in the assignment of ICD, CPT, and HCPCS codes and modifiers.

Documents individual encounter audit findings and communicates results to providers.

Accesses charge work queues to validate and assign charges.

Performs all required EMR functions as efficiently as possible and according to procedure.

Runs the delinquent data reports for unsigned charts to ensure all applicable accounts have been received, coded and billed in accordance with practice standards.

Demonstrates knowledge of current, compliant coder query practices when consulting with physicians or other healthcare providers when additional information is needed for coding and/or to clarify conflicting or ambiguous documentation.

Communicates effectively with staff, providers and leadership regarding documentation issues or needs.

Works leadership, when needed, to help resolve billing, claims, denials, and appeals issues affecting reimbursement.

Exhibits awareness of health record documentation or other coding ethics concerns. Notifies appropriate leadership for assistance, resolution when appropriate.

Utilizes EMR reports and/or communication tools to track missing documentation or queries that require follow-up to facilitate coding in a timely fashion.

Specific Knowledge, Skills, and Abilities: Ability to use a standard desktop/laptop, email and other Windows applications, if needed, Internet and web-based training tools preferred. Must be able to spend the majority of work time utilizing a computer, monitor, and keyboard. Ability to navigate between multiple systems and multiple computer applications. Strong oral and written communication skills. Excellent analytical and multi-tasking skills required. Proven ability to work independently with excellent time management skills. Ability to work with minimal supervision and exercise independent judgment. Ability to prioritize workload and work under pressure in a fast-paced environment with time constraints.

Required Education, Experience, and Licenses: Completion of an AHIMA-approved coding program or an AAPC-approved coding program, or Associates degree in Health Information Technology or a related field or an equivalent combination of years of education and experience is required.

Certified Professional Coder (CPC), Certified Coding Specialist-Physician-based (CCS-P), Certified Outpatient Coder (COC), Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA) or Certified Coding Specialist (CCS) is required.

Two (2) years of outpatient physician office evaluation and management (E/M) coding is required.

Candidates with previous outpatient physician office evaluation and management (E/M) auditing experience highly prioritized

Medent EMR experience candidates highly prioritized

CNY FAMILY CARE LLP

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