Title: Medical Coding & Billing Assistant 1
Location: New Haven CT United States
Full time
37.5 hours per week
Work Model: Remote
Essential Duties
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 work queues. 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.
. 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.
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.
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.
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.
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.
Position Focus:
Under the direction of the Clinical Operations Manager and reporting to the Clinical Revenue Specialist, the Coding and Billing Assistant 1 will be responsible for all aspects of charge submission for patient clinical services based on coding, documentation review, quality assurance, and compliance guidelines for the Department of Therapeutic Radiology. 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. Review and analyze documented medical services to verify accurate documentation and coding of services performed.
This position will be 100% remote. Selected candidate needs to be located within CT.
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 clinical services filed to charge review work queues as well as Radiation Oncology specific edit guidelines. Collect billing data and generate various reports daily from multiple systems (EPIC, ARIA Radiation Oncology EMR system. Initiate and maintain patient treatment summary sheets to track and monitor weekly treatments charges. Review, enter and validate charges in ARIA and EPIC. 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.
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. Ensures compliance within an academic medical practice.
Perform random medical record audits to verify billing and coding compliance under the direction of supervisors.
Provide coverage for billing and coding staff during vacation, sick or personal time which requires temporary schedule changes.
Perform additional functions incidental to account assistant and office/clerical activities as needed.
Preferred Education, Experience and Skills:
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. ROCC preferred but mandatory requirement within 18 months of employment. Oncology ICD-10 and coding experience preferred.
