Job Description:OverviewUnified 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 record
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
