Senior Biller & Coder (Healthcare)
Health Quest and Western Connecticut Health Network have combined to form a new nonprofit health system. The name for the new health system will be Nuvance Health. The new health system was created to provide communities across New York's Hudson Valley and western Connecticut with more convenient, accessible and affordable care.
Summary:
Performs accurate and timely ICD-10-CM and CPT coding, billing, and reconciliation of complex accounts. Serves as a department and subject matter expert (SME) in Cardiovascular and/or Radiology charging and coding. Proactively identifies and resolves barriers preventing revenue from crossing to financial system.
Responsibilities:
1. Performs ICD-10 and CPT-4 coding and medical supply charging. Charges and reconciles all complex accounts, including, but not limited to, interventional cardiac catheterization lab and/or interventional radiology procedures.
2. Identifies billing errors or missing revenue or charges for complex services based on raw data. Monitors revenue reports and patient schedules daily. Investigates and resolves issues to ensure charges and billing codes are entered in a timely manner. Assesses and identifies non-routine barriers to posting revenue and refers to supervisor or the proper authority.
3. Provides training on complex cases to staff engaged in billing and coding tasks. Performs the whole gamut of coding and charging tasks from routine to the most complex.
4. Performs ICD-10-CM diagnostic and CPT-4 coding at a minimum accuracy rate of 95%.
5. Research and resolves billing, coding, charging, and medical necessity edits for diagnostic and all interventional services with a high level of accuracy. Researches and resolves discrepancies so charges keyed reflects services delivered.
6. Performs charge master tasks, such as completing charge master paperwork, tracking changes until final screen building and new codes are in production. Routinely reviews compliance e-mails, coding journals, and modality newsletters. Compares coding updates to charge masters for areas of assignment. Communicates coding charge needs to department supervisors, managers, and other parties.
7. Research and resolve specialty-specific denials, discharged not final billed (DNFB) report, and charge error worklist (CEWL). Track trends and communicate findings with management team and appropriate departments (denials, financial clearance, etc.).
8. Maintains technical expertise for primary areas of revenue responsibility and all outpatient departments. Serves as back-up to employees and department supervisors for complex coding tasks. Provides billing and coding consultation for departments without revenue staff, i.e., Emergency Department and Pulmonary Medicine.
9. Collaborates with department supervisors and clinical department directors to ensure smooth revenue workflows. Identifies department-based barriers to timely revenue posting, such as workflow process steps and personnel. Participates in department performance improvement projects for revenue operations. Recommends process and policy changes to management team.
10. Attends and participates in required hospital education programs to maintain and enhance their coding skills and stay abreast of changes in codes, coding guidelines, and regulations.
11. Performs chart-to bill audits on complex interventional services on a monthly basis. Provides feedback to supervisors on employees to include in performance reviews, counseling, and staff education.
12. Assist supervisors with training new coders and experienced coders in new services. Provides 100% QA to new coders, coders learning new services, and coders on improvement plans.
13. Uses appropriate, accurate, and professional communication techniques when addressing billing barriers.
14. Exhibits strong competency in use of all computer systems and applications that are commonly used for position.
15. Achieves the organization's established expectations regarding customer service, teamwork, and safety.
16. Fulfills all compliance responsibilities related to the position.
17. Performs other duties as assigned.
Education: HS GRAD/EQUIVALENT
Essential: Strong analytical skills with attention to detail and a high degree of accuracy.
Required: Data entry, MS Word, MS Excel skills. Experience in charge capture process or medical record review. Strong verbal and written communication and analytical skills. Documented proficiency in use of ICD-10 and CPT-4 coding as required by position. Knowledge of how to accurately use ICD-10 and CPT-4 books. Sound knowledge of basic code structure is required.
Minimum Experience: Five years, with CPC certification, in charge capture process, medical record review, or coding for hospital-based departments. Long-term employees with
Working Conditions:
Manual: significant manual skills/motor coord & finger dexterity
Occupational: Little or no potential for occupational risk
Physical Effort: Sedentary/light effort. May exert up to 10 lbs. force
Physical Environment: Generally pleasant working conditions
Company: Nuvance Health
Org Unit: 1989
Department: Facility Charging and Coding
Exempt: No
Salary Range: $28.78 - $53.45 Hourly
