Responsible for supervising, evaluating, and improving the day-to-day operations of Medical Practice. Ensure accurate and timely billing of insurance claims and patient statements across 12 sites around NYC. Implement accurate medical coding policies and enhance operational processes. Serve as liaison between coding operations and clinical staff. Train and coach medical personnel on coding guidelines. Ensure accuracy and timeliness of clinical documentation.
Deliver accurate and timely billing for all sites and other entities. Review and enhance coding and billing process. Manage changes to procedure master, fee schedules, diagnosis tables, and modifier tables. Assist in orientation and training of Medical Practice and Medical Records staff, physicians, and IDT disciplines.
Establish and monitor systems for medical record storage and protection. Perform chart audits to assure diagnostic coding accuracy. Collaborate with medical directors and providers in QA reviews. Ensure coordinated care and communication across all disciplines.
Analyze and optimize coding processes for diagnosis data submission to Claims and CMS. Review Medicare financial reports relating to diagnostic data. Present HCC/RAF performance results to leadership and propose reimbursement maximization strategies. Monitor physician and clinic HCC/diagnoses performance.
Serve as subject matter expert for Risk Adjustment Data Validation (RADV) audits. Perform random audits of coding submissions by vendors.
Schedule: 8:30 AM – 5:30 PM, 40 hours/week.
Qualifications include college degree and one active professional certification (AAPC or AHIMA): CPC, CPMA, CPPM, CPB, or CRC.
Minimum three years experience in medical coding/billing. Working knowledge of Medicare and Medicaid. Ability to travel regularly across PACE sites. Strong attention to detail, critical thinking, and communication skills. Knowledge of HIPAA, CMS regulations. Preferred experience with EMR software (Athena) and provider portal (Stellar Health). Proficient in Microsoft Office, especially Excel.
Physical requirements include ability to stand and sit for extended periods, lift up to 50 pounds, bend/squat, maneuver stairs, demonstrate fine motor skills, and cognitive abilities required for job functions.
Employer is an equal opportunity employer committed to accessibility and accommodation.
- College degree required.
- Must have an active certification in one of the following: Certified Professional Coder (CPC), Certified Professional Medical Auditor (CPMA), Certified Professional Practice Manager (CPPM), Certified Professional Biller (CPB), or Certified Risk Adjustment Coder (CRC).
- Minimum 3 years of experience in medical coding and billing.
- Working knowledge of Medicare and Medicaid.
- Ability to travel regularly to multiple sites around NYC.
- Attention to detail, critical thinking, and strong time management.
- Excellent interpersonal and communication skills.
- Knowledge of healthcare regulations (HIPAA, CMS).
- Experience with EMR software such as Athena and provider portals like Stellar Health preferred.
- Proficiency in Microsoft Office Suite, especially Excel.
Physical requirements include ability to stand for up to 6 hours, sit for 6-8 hours, lift up to 50 pounds, and perform agility tasks.
Location
New York, US
Employment Type
Full-time
Experience Level
Senior
Salary Range
$75,000 - $85,000
Remote work allowed
No
Posted
3 weeks ago