Medical Coding and Billing Assistant 2

Position Focus :

Under the direction of Yale Medicine Administration (YMA) Coding and Billing, the Coding and Billing Assistant 2 is responsible for all aspects of accurate charge submission for patient clinical services based on coding, documentation review, quality assurance, and compliance guidelines. Requires comprehensive knowledge and expertise to exercise independent judgement and decision making on a regular basis with respect to all codes selected; ensure compliance with established coding guidelines, all YMA policies and protocols, third party reimbursement policies, Federal payer regulations, and HIPAA guidelines; maintain effective workflow processes to assure complete, accurate and timely billing activity and optimal reimbursements, while maintaining productivity to meet lag day expectations; responsible for recommending coding and billing change procedures to improve processes; review and analyze documented medical services to ensure accurate documentation and coding of all services. This opportunity is currently remote (work from home) within CT.

Required Knowledge, Skills & Abilities : Demonstrated ability to independently utilize and apply critical thinking skills. Comprehensive 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 surgical procedure reports, diagnostic studies, pathology, labs, and others as assigned, within an academic medical setting. Proficiency with electronic health record and practice application systems, electronic data entry and retrieval, and web-based applications and websites. Intermediate proficiency with MS Word, Excel, Outlook (emails and calendars), Zoom and PowerPoint. Demonstrated ability to independently perform all categories of coding / billing work, including all aspects of surgical coding. Comprehensive knowledge of Federal payer regulations, third party payers, HIPAA rules, reimbursement policies and procedures and Teaching Physician Guidelines within an academic medical practice. Proven ability to interpret and apply guidelines. Demonstrated ability to train others as well as to assist in QA process across multiple service lines. 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. Demonstrated ability to work independently with a high level of proficiency, accountability, and productivity. Organize and prioritize work with minimal supervision, as well as others as assigned. Ability to work in a fast-paced environment meeting timely deadlines while maintaining high productivity and quality standards. Ability to work effectively as a team member with common goals.

Essential Duties

1. Acts as an expert resource on proper procedural and diagnostic coding and changes in codes and coding practices as they reflect changes in medical practices. Based on a high level of medical knowledge of human anatomy and physiology in specialized medical fields and procedures, reviews and revises the coding of medical professionals, including physicians and APPs. Advises medical professionals and D-level Coding Specialists in order to ensure accuracy of coding and reimbursement of claims and compliance with government regulations and third-party carrier requirements. 2. Reviews operative and diagnostic reports, as well as procedures and E&M service documentation to validate diagnostic (ICD-10) and procedural (CPT / HCPCS) codes and modifiers with consideration given to charge review edits within work queues for Yale Medicine patient clinical services. Expert resource within the Epic Professional Billing application, ensuring that all charge review edits are appropriately resolved in charge review work queues to file clean, accurate claims, utilizing claim judgement and critical thinking skills. 3. Follows charge reconciliation processes to ensure all charges are being captured for all providers. Verifies all information required to produce and 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. Ensure compliance with Teaching Physician guidelines within an academic medical Pends charge sessions to seek corrective action for services not meeting documentation requirements in accordance with YMA policies and procedures. Identifies that a provider should be contacted to clarify or amend a medical record, following communication and escalation procedures. Modifies clinician’s selection. Exercises independent judgement and decision making on a regular basis with respect to all codes selected, applying critical thinking skills. Draws valid conclusions to support decision. Identifies provider issues that are trending and escalate per policy to minimize rejections and audit risk that could result in substantial financial costs to the department and Adheres to YMA policies and procedures and Yale Medicine’s Mission, Values and Guiding Principles. Active participation in team and department training and education programs and staff meetings. Establish and cultivate productive relationships among staff to support a positive team environment and professional interactions. Maintain professional and technical knowledge by participating in educational workshops and reviewing professional publications. 6. Works with manager or designee to identify educational opportunities for colleagues and providers, as well as system edits to enhance accuracy and productivity within Epic. Perform independent research using available digital and website resources to provide recommendations for coding, billing, and documentation questions when escalation is May perform other duties as assigned.

Required Education and Experience

Six years of related work experience, four of them in the same job family at the next lower level, and a high school level education; or four years of related work experience and an Associate degree; or little or no work experience and a Bachelor degree in a related field; or an equivalent combination of experience and education.

Required Skill / Ability 1 :

Demonstrated ability to apply critical thinking skills. Comprehensive knowledge of ICD-10, CPT, HCPCs and modifier coding, medical terminology, human anatomy, and digital coding resources / software. Ability to analyze and interpret evaluation & management documentation guidelines and surgical procedure reports, diagnostic studies, pathology, and labs.

Required Skill / Ability 2 :

Proficiency with electronic health record and practice application systems, electronic data entry and retrieval, and web-based applications and websites. Intermediate proficiency with MS Word, Excel, Outlook (emails and calendars), Zoom and PowerPoint.

Required Skill / Ability 3 :

Demonstrated ability to independently perform all categories of coding / billing work, including all aspects of surgical coding. Comprehensive knowledge of Federal payer regulations, third party payers, HIPAA rules, reimbursement policies and procedures and Teaching Physician Guidelines within an academic medical practice. Proven ability to interpret and apply guidelines

Required Skill / Ability 4 :

• Demonstrated ability to train others & to assist in QA process across multiple service lines. Demonstrated strong interpersonal, verbal, & written communication skills. Effectively communicate with team members to resolve questions on assignments. Effectively communicate with providers, following escalation processes with analytics team & manager

Required Skill / Ability 5 :

Ability to work independently with a high level of proficiency, accountability, and productivity. Organize and prioritize work with minimal supervision, as well as others as assigned. Ability to work in a fast-paced environment meeting timely deadlines while maintaining high productivity and quality standards. Ability to work effectively as a team member with common goals.

Preferred Education, Experience and Skills :

Additional specialty coding credential.

Required Licenses or Certifications

Certified Professional Coder (CPC) through AAPC organization. Must maintain certification through annual education requirements.

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.

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.