University of Rochester Billing Analyst-Coder in Rochester, New York
Full Time 40 hours Grade 009 Patient Financial Services
8 AM-4:30 PM
With considerable latitude for independent judgment, the Billing Analyst/Coder is responsible for resolving hospital outpatient claims that are unbilled due to Medicare/Medicaid APC/APG grouper holds and edits. In addition, the Billing Analyst/Coder is responsible for assisting billing staff with claims denied by 3rd party payors due to billing/coding issues (i.e. modifiers and related cpt ranges). This position is responsible for outpatient accounts for all payers, excluding Ambulatory Surgery, ED and Cardiac Cath procedures. This position represents Strong Memorial Hospital to multiple ambulatory departments and providers in a professional, collaborative approach to assure on-going positive relationships.
- Through detailed knowledge of third party billing/coding requirements, payor and governmental contracts, determine the most effective method to evaluate root cause of hold or edit and bring unbilled visit to complete resolution (claim billed/accepted by payor).
- Through research of outstanding holds and edits, document (by department) areas of opportunities to prevent future billing delays. Present documentation to the ambulatory department, either in person or via email, in a professional, collaborative manner. Documentation must include references and billing rules to support the necessary corrective action.
- Schedule follow-up activities with departments on corrective actions to assure compliance with billing and coding rules. Maintain documentation of notification, corrective actions, and monitoring of current visits to assure that the issues have been fully resolved.
- Identify and clarify issues that require management intervention. Research and prepare problem accounts for insurance representatives/Supervisor to review for claims which have denied inappropriately based on known billing and coding rules. Attend payor meetings to present and discuss denials and differences in coding interpretation.
- Assist with obtaining and review of documentation requests for outpatient ADRs as time permits.
Associate’s degree in business field and 4-5 years’ experience in hospital billing, accounting, and/or coding; or an equivalent combination of education and experience. CPC/CCS in good standing and maintained through continuing education. Exceptional verbal and written communication skills with demonstrated leadership and customer service skills. Knowledge of Microsoft Office programs (Excel, Word, Email).
EOE Minorities/Females/Protected Veterans/Disabled
Job Title: Billing Analyst-Coder
Location: Strong Memorial Hospital
Job ID: 208476
Full/Part Time: Full-Time