Medical Coding and Billing Assistant 1

Position Focus :

Under the direction of Yale Medicine Administration (YMA) Coding and Billing, the Coding and Billing Assistant 1 is responsible for reviewing all aspects of charge submission for patient clinical services based on coding, documentation review, quality assurance, and compliance guidelines. Reviews charge submissions for compliance with established coding guidelines, all YMA policies and protocols, third party reimbursement policies, Federal payer regulations, and HIPAA guidelines. Performs effective workflow processes to file complete, accurate and timely billing of professional charges, while maintaining productivity to meet lag day expectations. May review and analyze documented medical services to verify accurate documentation and coding of services performed.

Essential Duties

1. Performs work queue resolution of medical billing charge sessions by reviewing clinical documentation to confirm diagnostic (ICD-10) and procedural (CPT / HCPCS) codes and modifiers, based on charge review edits for Yale Medicine patient clinical services filed to charge review workqueues. May perform manual charge entry for non-Epic services. With an ability to navigate within the Professional Billing applications, ensures that all charge review edits are appropriately resolved in charge review work queues utilizing claim judgement and critical thinking skills. Draws valid conclusions to support decisions. 2. May verify all information required to submit a clean claim including provider, place of service, date of service, bill area, all codes and special billing procedures that may be defined by a payer, contract or YMA. Ensures compliance with Teaching Physician guidelines within an academic medical practice. 3. Pends charge sessions to seek corrective action for services not meeting documentation requirements in accordance with YMA policies and procedures. May identify that a provider should be contacted to clarify or amend a medical record, following communication and escalation procedures. May modify clinician’s selection. 4. Adheres to YMA policies and procedures and Yale Medicine’s Mission, Values and Guiding Principles. Actively participates in team and department training and education programs and staff meetings. Establishes and cultivates productive relationships among staff to support a positive team environment and professional interactions. Maintains professional and technical knowledge by participating in educational workshops and reviewing professional publications. 5. May perform other duties as assigned.

Required Education and Experience

Four years of related work experience, two of them in the same job family at the next lower level, and high school level education; or two years of related work experience and an Associate’s degree, or an equivalent combination of experience and education.

Required Skill / Ability 1 :

General / intermediate knowledge of ICD-10, CPT, HCPCs and modifier coding, medical terminology, human anatomy, and digital coding resources and software. Ability to analyze and interpret evaluation and management documentation guidelines as well as procedures and applicable coding guidelines.

Required Skill / Ability 2 :

Demonstrated ability with an electronic health record and practice application systems, electronic data entry, and web-based applications and websites. Intermediate proficiency with MS Word, Excel, Outlook (emails and calendars).

Required Skill / Ability 3 :

Demonstrated knowledge of Federal payer regulations, third party payers, HIPAA rules, reimbursement policies and procedures. Proven ability to interpret and apply guidelines.

Required Skill / Ability 4 :

Demonstrated strong interpersonal, verbal and written communication skills. Ability to effectively communicate with team members to resolve questions regarding collaboration and assignments. Communicate effectively with providers, following escalation processes with analytics team and manager.

Required Skill / Ability 5 :

Demonstrated ability to work independently; organize and prioritize own work with minimal supervision; ability to work in a fast-paced environment meeting timely deadlines while maintaining productivity and quality standards. Ability to work effectively as a team member with common goals.

Preferred Education, Experience and Skills :

Previous Epic experience; experience within an academic medical environment or large multi-specialty practice; CPC certification preferred.

Required Licenses or Certifications

Certified Professional Coder Apprentice (CPC-A) through AAPC organization. Must maintain certification through annual education requirements and achieve CPC status within 2 years.

Physical Requirements

Ability to push, pull, and lift in excess of 20 pounds as well as travel around the medical school campus.

Drug Screen

Health Screening

Background Check Requirements

All candidates for employment will be subject to pre-employment background screening for this position, which may include motor vehicle, DOT certification, drug testing and credit checks based on the position description and job requirements. All offers are contingent upon the successful completion of the background check. For additional information on the background check requirements and process visit "Learn about background checks" under the Applicant Support Resources section of Careers on the It's Your Yale website.

Health Requirements

Certain positions have associated health requirements based on specific job responsibilities. These may include vaccinations, tests, or examinations, as required by law, regulation, or university policy.

Posting Disclaimer

The intent of this job description is to provide a representative summary of the essential functions that will be required of the position and should not be construed as a declaration of specific duties and responsibilities of the particular position. Employees will be assigned specific job-related duties through their hiring departments.