Job Posting Closing Date: Open until Filled

Where do you belong?

Your career is more than just a job, it's part of your life. Whether you’re a clinician, or non-clinical professional, at USACS you'll feel a sense of connection working with clinicians and office staff who share your interests and values. We want you to love coming to work each day because you believe in what you do and the people with whom you work. We care about your success.

USACS also understands that location is important. We offer career opportunities for clinicians and non-clinical support staff from New York to Hawaii and numerous points in between. Our supportive culture, outstanding benefits and competitive compensation package is best in class.

Job Description

The Billing and Coding Compliance Analyst conducts internal audits of emergency medicine and inpatient (hospitalist) professional services to ensure billing codes comply with official ICD-10 coding guidelines and CPT/HCPCS coding conventions. The role of the individual is to educate stakeholders to ensure that data within the medical record is coded efficiently and accurately for appropriate reimbursement and medical necessity to meet regulatory requirements.

ESSENTIAL JOB FUNCTIONS:

• Review and audit coding practices to verify adherence to ICD-10, CPT-4, HCPCS codes, CMS guidelines, and other relevant regulations. Document audit findings and create comprehensive reports.
• Oversee corrective actions and remediation plans resulting from audits and special projects.
• Perform follow-up audits to confirm the effectiveness of implemented solutions.
• Coordinate coding compliance audits, including electing the sample size, facilitating communication with external auditors and internal stakeholders, analyzing audit results, and ensuring timely completion with all necessary follow-up actions.
• Evaluate the quality of clinical documentation to identify incomplete or inconsistent documentation that could impact the quality of data submitted and/or reported, trends found during chart reviews, third-party audit findings, and annual coding updates.
• Evaluate and appeal federal health care program claims denials, adverse audit results, and sanctions. Identify trends.
• Research governmental regulations (including, but not limited to, Medicare transmittals, Manuals, Local Coverage Determinations (LCDs), National Coverage Determinations (NCDs), and coding guidelines (including, but not limited to, CPT Assistant, NCCI, and Coding Clinic) pertinent to audits and department requests.
• Perform data analytics to identify outliers and coding trends. Demonstrate the ability to analyze coded data to identify risk areas and provide suggestions for documentation improvement.
• Maintain a database to track and report internal and external appeals, coding reviews, and internal and external audits.
• Make recommendations for coding policy/guideline changes.
• Perform other duties as assigned.

KNOWLEDGE, SKILLS AND ABILITIES:

• Possess effective time management skills to permit handling of large workloads.
• A thorough understanding and knowledge of Medicare rules and regulations is required.
• Experienced medical auditor to identify billing discrepancies and optimize reimbursement.
• Possess extensive knowledge of ICD-10 and CPT coding to ensure accurate claim submission.
• Knowledge and understanding of a broad scope of functions within the healthcare compliance industry, with specific emphasis on federal and state laws and regulations.
• Possess a strong foundation in business principles and a demonstrated ability to stay current on evolving practices and procedures.
• Ability to effectively communicate both orally and in writing with coworkers to coordinate operations with other departments to ensure that business requirements are satisfied.
• Ability to organize and communicate detailed/complex research.
• Ability to identify and communicate emerging issues to management.
• Ability to pay close attention to detail.
• Ability to maintain confidentiality.
• Strong analytic, problem-solving, and process improvement skills.
• Ability to organize and prioritize job tasks and requirements.
• Strong working knowledge of Microsoft Office products, including Word, PowerPoint, Excel, and Access.
• Ability to effectively perform in a multi-task work environment.
• Ability to exhibit a commitment to teamwork, support alignment with company and department goals and objectives, assist others in developing their knowledge of the company and process, adapt to change positively, and work proactively with minimal supervision.

EDUCATION AND EXPERIENCE:

• Two years of medical coding experience required.
• RHIA/RHIT/CCS/CPC/CPMA certification required.
• Emergency Medicine and/or Inpatient (Hospitalist) Medicine professional fee coding experience required.
• Graduation and experience from an accredited medical billing/coding education program preferred.
• Associate or bachelor’s degree preferred.

PHYSICAL DEMANDS:

• While performing the duties of this job, the employee is regularly required to sit for prolonged periods and occasionally walk, stand, bend, stoop, and lift up to 15 pounds.
• Close visual acuity is required to perform the job.

Salary Range:

$44,906.00 - $83,076.00