Job Description
Revenue Cycle Specialist-Revenue Integrity Title: Revenue Cycle Specialist-Revenue Integrity
Location: Midtown
Org Unit: AR - Coding Medicine
Work Days:
Weekly Hours: 35.00
Exemption Status: Non-Exempt
Salary Range: $29.15 - $35.00
*As required under NYC Human Rights Law Int 1208-2018 - Salary range for this role when Hired for NYC Offices
Position Summary Remote position - Join a team of dedicated revenue cycle professionals in the Central Business Office (CBO) of Weill Cornell Medicine (WCM). Apply your knowledge as a Certified Professional Coder to investigate and resolve coding related insurance payment denials. The CBO partners with WCM Clinical Departments to increase and expedite service revenue, reduce aged AR, and trend denials for their root causes thereby driving efficiencies, to include clinical documentation improvement and coding denials prevention.
Job Responsibilities - Performs retrospective coding and documentation review of denied charges for physician services. Reviews medical records for completeness and accuracy to ensure documentation supports the services billed and all documentation standards are met for billing.
- Analyze for invalid denial trends, payer specific carrier submission requirements & system optimization.
- Performs extensive follow-up to investigate and resolve payment denial trends.
- Resolves outstanding accounts utilizing ancillary applications and websites as tools to retrieve medical documentation, claim status and billing guidelines to substantiate corrected claim submissions, written appeals, coding and medical necessity reviews.
- Researches and interprets payer contract terms and compiles necessary supporting documentation templates for appeals according to various payer claim guidelines.
- Ensures denial reviews are conducted in a timely manner.
- Maintains up-to-date policies and procedures and knowledge related to managed care and third party payors.
- Participates in annual and on-going mandatory compliance training. Fulfills Continuing Education Units necessary to maintain certification status.
- Assists in training current and new employees on the use of systems and departmental policies and procedures.
- Performs other related duties as assigned.
Education - High school diploma or GED in related field
Experience - Certification as a Certified Professional Coder (CPC) or Certified Coding Specialist (CCS).
- Should be certified from AHIMA or from AAPC.
- Approximately 3-5 years of physician billing experience, specifically accounts receivable and collection experience.
- Prior experience working with an eMR systems.
- Knowledge of medical terminology.
- Knowledge of third-party reimbursement.
- Microsoft Excel and other reporting software to sort, filter, summarize and identify various account receivable trends.
Knowledge, Skills and Abilities - Proficient in CPT and ICD10 CM coding guidelines.
- Ability to meet productivity standards and identify any issues or trends and bring them to the attention of management.
- Demonstrated ability to function independently and exercise independent judgment.
- Demonstrated critical thinking and analytical skills.
- Ability to meet daily coding and denial management production requirements along with quality as per Company norms.
- Strong computer skills in data entry, coding, knowledge of Electronic Medical Record software (Epic), Microsoft Office, Excel.
- Ability to follow coding guidelines and legal requirements to ensure compliance with our Institutional, federal, and state regulations.
- Excellent interpersonal, verbal and communication skills.
Licenses and Certifications - Certified Professional Coder Certificate (CPC) or Certified Coding Specialist (CCS)
Working Conditions/Physical Demands Remote based work with rare onsite requirement. Dedicated workspace conducive to a healthy work environment.
Weill Cornell Medicine is a comprehensive academic medical center that is committed to excellence in patient care, scientific discovery, and the education of future physicians and scientists in New York City and around the world. Our doctors and scientists - faculty from Weill Cornell Medical College, Weill Cornell Graduate School of Medical Sciences, and the Weill Cornell Physician Organization - are engaged in world-class clinical care and cutting-edge research that connect patients to the latest treatment innovations and prevention strategies. Located in the heart of the Upper East Side's scientific corridor, Weill Cornell Medicine's powerful network of collaborators extends to its parent university Cornell University; to Qatar, where an international campus offers a U.S. medical degree; and to programs in Tanzania, Haiti, Brazil, Austria and Turkey. Our medical practices serve communities throughout New York City, and our faculty provide comprehensive care at NewYork-Presbyterian Hospital/Weill Cornell Medical Center, NewYork-Presbyterian/Lower Manhattan Hospital, NewYork-Presbyterian Hospital/Brooklyn Methodist Hospital, NewYork-Presbyterian Hospital/Westchester Behavioral Health Center, and NewYork-Presbyterian/Queens. At Weill Cornell Medicine, we work together to treat each individual, not just their conditions or illnesses, as we strive to deliver the finest possible care for our patients - the center of everything we do. Weill Cornell Medicine is an Equal Employment Opportunity Employer. Weill Cornell Medicine provides equal employment opportunities to all qualified applicants without regard to protected status, including race, sex, sexual orientation, gender identity, national origin, color, age, religion, protected veteran or disability status, or genetic information.
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About Weill Cornell Medicine
Weill Cornell Medicine is a global healthcare leader known for the world-class patient care, cutting-edge research and top-ranked education. Every day, the employees of Weill Cornell Medicine improve lives across the city and around the globe. They help patients stay well, and our benefits and programs aim to help our employees and their families stay well by supporting their physical, financial, and professional health.
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