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Reimbursement Specialist CPC - Surgery

Company: Albany Medical Center
Location: Albany
Posted on: January 27, 2023

Job Description:

Department/Unit:

Physicians Billing

Work Shift:

Day (United States of America)

The Reimbursement Specialist- CPC is responsible for correct coding, charge entry and reimbursement/denial follow up tasked by their team lead. This position will code clinical and procedural/surgical CPT and ICD-10-CM diagnosis for professional charges and review charges and documentation supplied by providers and medical staff to ensure they are compliant with federal and state regulations and laws as well as other insurance carrier guidelines. Timely and accurate completion of day-to-day processing of all clinic and procedural coding and charge entry for multiple interfaced systems.

This position will assist the team lead in serving as the Practice Coding Operations liaison between the assigned Departments and MCPG. Must be efficient with electronic medical records and knowledgeable of various insurance company billing policies and procedures. Must have ability to work with minimum-to-moderate direct supervision and as a team player with other practice staff members.

GENERAL DUTIES (to include but not limited to):

  • Must be able to adapt to a large, complex, multi-system business environment, confer with both internal and external customers and vendors and assist in managing the expectations of a diverse and demanding User constituency.
  • Work with the team lead within assigned departments to support and streamline day to day workload.
  • Must have extensive knowledge of clinic and procedure based coding.
  • Assist in creating and updating policies and procedures to be used within the designated departments.
  • Work department reports and assigned work queues and bring feedback to coding team lead to ensure proper coding and avoid future delays in payment.
  • Work with minimal supervision on assignments.
  • Identify any coding or payer changes and bring that information to the team lead and providers to ensure proper coding.
  • Supports development tools, procedures and methods for daily operational support.
  • Works with the team lead on routine, well defined, analysis type problems related to coding and reimbursement.
  • Fulfills department requirements in terms of providing work coverage and administration notification during periods of personnel illness, vacation or education.
  • Maintain HIPAA confidentiality at all times.
  • Other duties or assignments as designated by management.
    Requirements:

    • Certified Professional Coder (CPC). Must be a member in good standing of the American Academy of Professional Coders and maintain biannual continuing education credits (36) to solidify up-to-date knowledge and understanding of professional medical coding.
    • Certificate of ICD-10-CM Proficiency for diagnosis coding is required.
    • Apply correct coding guidelines to multiple source system entries for coding and charge entry.
    • Timely and accurate completion of day-to-day processing of all clinic and procedural coding and charge entry for multiple interfaced systems.
    • Assist team lead in defining and submitting RCx rules for consideration to streamline coding accuracy and efficiency within multiple interfaced systems.
    • Knowledge of insurance, managed care, Medicaid and Medicare regulatory requirements.
    • Strong attention to detail and critical thinking skills.
    • Strong organizational and time management skills.
    • Assist in data analysis and development of logical solutions to coding and reimbursement problems
    • Interface effectively and cooperatively with computer system and their Users to maintain efficient system utilization; recommend appropriate revisions to processes, procedures, and operations.
    • Assist with testing and implementation of third-party vendor applications software.
    • Ability to work well with people from different disciplines with varying degrees of business and technical expertise.
    • Good interpersonal relationship skills.
      Thank you for your interest in Albany Medical Center!---

      Albany Medical is an equal opportunity employer.

      This role may require access to information considered sensitive to Albany Medical center, its patients, affiliates, and partners, including but not limited to HIPAA Protected Health Information and other information regulated by Federal and New York State statutes. Workforce members are expected to ensure that:

      Access to information is based on a "need to know" and is the minimum necessary to properly perform assigned duties. Use or disclosure shall not exceed the minimum amount of information needed to accomplish an intended purpose. Reasonable efforts, consistent with Albany Med Center policies and standards, shall be made to ensure that information is adequately protected from unauthorized access and modification.

      Albany Med is the centerpiece of medicine, research, and medical education in New York's CapitalRegion and is the area's largest private employer with more than 10,000 employees.

      Albany Med offers excellent career opportunities in a wide range of roles in both patient care andadministration. We value all our staff members and offer outstanding employee benefits including:

      • Excellent health care coverage ( with lower copays at most Albany Med providers.
      • A wide array of services and programs to support emotional, physical, and mental wellbeing (
        Anchored in the state's historic capital city, Albany Med offers a full range outpatient and inpatient careand is home to the region's largest hospital, only Level 1 trauma center, and only children's hospital. Thedowntown campus also offers opportunities at Albany Medical College.

        Albany Med partners with Columbia Memorial Health, Saratoga Hospital and Glens Falls Hospital to form the Albany Med Health System, serving more than three million people over 25 counties.

Keywords: Albany Medical Center, Albany , Reimbursement Specialist CPC - Surgery, Other , Albany, New York

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