MEDICAL AUDIT ANALYST

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Job description

The Medical Coding Analyst is responsible for the resolution of complex coding inquiries, while also supporting various specialties by reviewing the coding of claims (i.e. ICD-10, CPT-4, etc.) and/or auditing medical charts to ensure that data is complete and supports codes assigned for optimal reimbursement and in compliance with Federal, State and private industry mandates.

The Medical Coding Analyst will also provide analysis identifying trends with root causation and identification of areas of opportunity for provider education while implementing stringent tracking measurements for outcomes. The medical coding analyst will also be responsible for various training and educating tasks as assigned.

Job Responsibilities

Identify and review all types of procedure billing with documented information to correct various coding errors.

Ensure compliance with State and Federal regulations. Identify and report for various state requirements.

Review medical records to ensure data is complete and supports procedures reported. Determine and apply appropriate billing mechanisms (LOA) etc.

Participate in various programs that affect coding, clinical data and billing optimization.

Collaborate with the departments and providers to achieve documentation that supports the services rendered.

Assist physicians in documentation issues and in providing data.

Initiates and conducts analysis of coding trends to identify missing, incomplete, or questionable data.

Conduct audits followed by education to providers and/or departments.

Assists in educating staff with accurate and appropriate assignment of ICD-10, CPT/HCPCS, and modifiers for the purposes of billing to ensure maximum reimbursement while also ensuring compliance with regulatory and payer guidelines

Assist in research and other analytical projects such as evaluating billing and coding practices within departments to ensure compliance and/or identify enhanced revenue opportunities

Assist in researching CMS, Medicaid, and Payor Guidelines to ensure adherence to correct Coding and Billing Principles surrounding Payor Policies

Qualifications

High School Diploma Required, Bachelor's Preferred

AAPC CPC Certification Required

Must maintain their annual credits mandated by the AAPC

Trained in ICD-10, HCPC, and CPT-4 coding

Strong organizational, analytical and writing skills.

Excellent verbal and communication skills.

Ability to educate staff and the physicians.

Proficiency with auditing visit notes, procedure notes for various specialties.

Advanced proficiency with research and problem-solving skills as it relates to Coding required.

Ability to identify trends and report findings.

Comprehensive knowledge and experience with Provider Based Billing a plus

Proficiency with CMS, Medicaid, and Payor Guidelines as it relates to Coding and Billing Principles.

EPIC experience required.

EXCEL proficiency preferred.

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Shift: filter2 Scheduled Hours: filter6 Req ID: id Salary Range/Pay Rate: customSalmin - customSalmax customRate

For positions that have only a rate listed, the displayed rate is the hiring rate but could be subject to change based on shift differential, experience, education or other relevant factors.

To learn more about the "Montefiore Difference" - who we are at Montefiore and all that we have to offer our associates, please click .

Diversity, equity and inclusion are core values of Montefiore. We are committed to recruiting and creating an environment in which associates feel empowered to thrive and be their authentic selves through our inclusive culture. We welcome your interest and invite you to join us.

Montefiore is an equal employment opportunity employer. Montefiore will recruit, hire, train, transfer, promote, layoff and discharge associates in all job classifications without regard to their race, color, religion, creed, national origin, alienage or citizenship status, age, gender, actual or presumed disability, history of disability, sexual orientation, gender identity, gender expression, genetic predisposition or carrier status, pregnancy, military status, marital status, or partnership status, or any other characteristic protected by law.

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