Coding Analyst

Overview

*Temp Role*

Unified Women’s Healthcare is a company dedicated to caring for OB/GYN providers who care for others, be they physicians or their support staff. A team of like-minded professionals with significant business and healthcare experience, we operate with a singular mindset - great care needs great care. We take great pride in not just speaking about this, but executing on it.

As a company, our mission is to be an indispensable source of business knowledge, innovation and support to the practices in our network. We are advocates for our OB/GYN medical affiliates – enabling them to focus solely on the practice of medicine while we focus on the business of medicine.

We are action oriented. We strategize, implement and execute – on behalf of the practices we serve.

The Coding Analyst is entrusted with the job of reviewing, auditing and coding provider’s documentation for the purpose of reimbursement, training, education and compliance using ICD-10 and CPT codes. The successful applicant will serve as an information resource and guide to our providers, clinical staff, practice managers, members of the Revenue Cycle team and other leadership. This position will be directly involved in analyzing pre-bill claim edits, claim denials and AR management, and working alongside the Revenue Specialists, will review and amend denied claims to ensure accurate coding and adherence to payor policy requirements. The Coding Analyst will assist the Revenue Cycle Manager in proactive audits of medical charts and records for compliance with federal coding regulations and guidelines. This role utilizes knowledge of client systems and procedures to provide a second level review of codes assigned to medical diagnoses and clinical procedures, ensuring that medical billing conforms to legal and procedural requirements. The Coding Analyst reviews, develops, and/or modifies client procedures, systems, and protocols to achieve and maintain compatibility with billing requirements and compliance standards.

Responsibilities

• Provide second-level review of billing performances to ensure compliance with legal and procedural policies and to ensure optimal reimbursements while adhering to regulations prohibiting unbundling and other questionable practices
• Audit medical record documentation to identify under-coded and over-coded services; prepare reports of findings and meet with providers to provide education and training on accurate coding practices and compliance issues
• Interact with physicians and other patient care providers regarding billing and documentation policies, procedures, and regulations; obtain clarification of conflicting, ambiguous, or non-specific documentation through provider queries
• Submit any issues or trends found within documentation by a physician and /or physician extender to Revenue Cycle Manager and/or practice administrator
• Interact with Revenue Specialists and practice billing specialists to ensure appropriate and complete follow-up of patient accounts to maximize reimbursement through AR management processes, including corrections and resubmissions as needed
• Analyze individual payor performances regarding fee schedule reimbursements and trends
• Research, analyze, and respond to inquiries regarding compliance, payor policies and guidelines, inappropriate coding, denials, and billable services
• Monitor and distribute communications regarding payor policy changes and updates, in relation to our provider specialties
• Provide training, guidance and oversight to staff less experienced in coding guidelines
• Serve as an information resource and guide to clinicians, champion the need to change coding behaviors and serve as subject matter expert
• Train, instruct, and provide support to medical providers and practice billing specialists as appropriate regarding coding compliance, documentation, and regulatory provisions, and third-party payor requirements
• Review, develop, modify, and adapt relevant client procedures, protocols, and data management systems to ensure compliance with organization’s policies
• Interact with providers and management to review and/or implement codes and to update charge documents
• Illustrate excellent knowledge of healthcare industry regarding the revenue cycle, coding, claims, and state insurance laws
• Ensure strict confidentiality of financial and medical records
• Perform miscellaneous job-related duties as assigned

Qualifications

• Certified Professional Coder (CPC) certification required
• Minimum of 5 years’ experience as a biller, collector, coder, or back office support staff, or other equivalent medical industry experience
• OB/GYN experience preferred, but not required
• Associates degree from an accredited university preferred
• Knowledge of auditing concepts and principles
• Advanced knowledge of medical coding and billing systems and regulatory requirements
• Ability to use independent judgment and to manage and impart confidential information
• Ability to analyze and solve problems
• Ability to travel (up to 25%, as needed)
• Strong communication and interpersonal skills
• Knowledge of legal, regulatory, and policy compliance issues related to medical coding and billing procedures and documentation
• Knowledge of current and developing issues and trends in medical coding procedures requirements