Cayuga Health and its affiliates are the region's leading healthcare system and most trusted providers of integrated health services, empowering our people in our mission to equitably improve the well-being of the communities we serve. Our commitment to providing extraordinary healthcare begins with our team of extraordinary professionals who are continuously discovering clinical innovations and enhancing access to the most up-to-date facilities, equipment, technologies, and research protocols. Cayuga Health's commitment to our employees includes competitive compensation, comprehensive employee benefits programs, and the opportunity to explore and build a career in healthcare through our many professional development programs.

Summary: Responsible for having a working knowledge of ICD-10 coding in addition to CPT 4 coding and the correct use of billing modifiers. Responsible for understanding and following specific payer guidelines for medical necessity. Includes properly reviewing medical records for completeness prior to charge entry. Assists with compliance, education, accuracy in charge capture, and improvement in the revenue cycle. Optimizes revenue and maximize control procedures at Cayuga Cancer Center by monitoring performance metrics of front-end staff with regard to revenue cycle responsibilities. Acts as the super-user for patient accounts/ledger information. Reports updates to the System Director of outstanding issues for billing purposes on services provided by the providers and or clinical staff. Also acts as a liaison with the hospital billing department to address billing issues and denials as they arise.

Roles and Responsibilities:

Maintains current expert knowledge in billing and revenue cycle
Audits performance metrics to assure that performance meets expectations
Reconcile all charges against scheduled to ensure all services are being billed
Verifies note completion for all charges prior to charges being entered into EMR
Requests documentation completion from appropriate party as necessary
Familiarity with billing nuances for specific payers assuring those charges are captured appropriately and according to contract.
Accurate use of appropriate modifiers when entering charges
Familiar with the use of ICD-10 code book and assist staff/providers with assigning appropriate codes
Generate report identifying missing charges or documentation to be shared with staff/providers at determined interval
Generate appropriate billing and documentation to be sent to CMA for Cortland and Schuyler billing
Act as contact for billing department staff when questions arise concerning oncology services
Assists billing department staff in correcting claims for resubmission of claims if original is denied
Familiar with navigating websites in an effort to investigate insurance specific payment policies
Update demographic/insurance information as necessary
Provide staff education regarding account types and insurance specific requirements as necessary
Reviews all claims for completeness before submitting to coding
Attend monthly meetings to review any revenue cycle issues
Evaluate new procedures to ensure revenue optimization for Cayuga Cancer Center to determine coverage and potential reimbursement for various payers.
Assists Cayuga Cancer Center with denial investigations and root cause analysis. Including identifying opportunities for denial prevention and any necessary follow-up with payers to resolve any denial errors.
Maintains working knowledge of coding and billing regulations for all payers. Keeps current on regulatory updates, including NYS insurance laws and regulations, local payer policies and procedures to ensure charge accuracy, compliance and optimization for Cayuga Cancer Center.
Is flexible in assuming other appropriate responsibilities not noted above.

Required Skills and Experience:

Possession of a High School Diploma or GED
Strong verbal and written communication skills
Typing skills, calculator skills
Knowledge of medical terminology, ICD10 and CPT 4 coding systems
Strong organizational skills
Must possess demonstrated knowledge of clinical processes, clinical coding (CPT, HCPCS, ICD-10-CM/PCS, revenue codes and modifiers), NYS insurance regulations, billing processes, including knowledge of charge capture, reconciliation, error management operations and overall revenue cycle operations required

Preferred Skills and Experience:

Appropriate mix of education/experience, preferred

Physical Requirements:

sitting: 70%
standing: 30%
reaching: 80%
bending: 10%
lifting: must be able to lift 40 lb.

Location and Travel Requirements:

Hybrid - CMC
M-F 8am-4:30pm

Compensation Disclosure:

$18.50 to $24.00 per hour

Cayuga Health System and its affiliates are committed to treating all patients, providers, staff and volunteers equitably and with dignity, ensuring the highest levels of safety, care and respect, and striving to recognize and overcome biases and policies that contribute to disparities in healthcare access, equitable care and positive health outcomes for all.

We are proud to be an Equal Employment Opportunity employer, supporting the growth and health of our employees and community by embracing the rich diversity, needs and circumstances of all peoples and prioritizing opportunities to build a diverse and inclusive workplace. We do not discriminate based upon race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable protected characteristics.

Cayuga Health System jobs

Billing Specialist