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Senior Reimbursement Analyst

New York, NY 10029

Department: Revenue Job Number: 6257 Pay Rate: $80000-89000 Employment Type: Full Time

Job Description

Our client, a leading academic medical center in NYC, is hiring a Senior Reimbursement Analyst.
Responsibilities:
  • Conduct multi-specialty charging/coding reviews to determine what charge(s) need to be added, deleted, &/or updated to satisfy coding and other CDM edits.
  • Analyze accounts primarily when procedure codes are reported without a corresponding device or drug charge then review OR/procedure reports to ensure coding accuracy, research device log for missing or questionable charges & liaison with Operations &/or device/pharmacy team for the required update/s.
  • Based on specific account edits, review the patient’s medical record along with current coding guidelines to ensure that the correct CPT, diagnosis code(s), and modifiers are accurately captured by the HIM or clinics.  When appropriate, initiate charge addendums in Epic to get missing charges interface to the account.
  • Assist with suspense reports by reviewing documentation associated each assigned encounter and determine what code/s need to be reported or deleted from the file.
  • Conduct RAC reviews and assist PFS with an outlined checklist of all coding, documentation and billing requirements need for each encounter under review. 
  • Review operative reports and suggest coding updates to HIM on all surgical reviews, as needed.
  • Analyze incorrect charging &/or incorrect coding trends to identify patterns and root causes and share findings with the supervisor on a weekly productivity report for a resolution
  • Assist PFS with coding-related denials and when needed prepare appeal letters including supportive coding guidelines from credible sources such as AMA, CPT Assistant, AHA coding clinic, and NCCI Policy Manual.
  • Monitor all assigned edits/WQs to avoid or reduce delinquent accounts.
  • Work with department managers and HIM as needed to ensure the appropriate charges &/or coding are submitted to maximize reimbursement while adhering to coding & billing regulations.
  • Adept at comparing documentation, code assignment and charge for accuracy and completeness and elevating concerns to supervisor
  • Have a good working knowledge of CPT coding guidelines, NCCI edits/ICD-10 guidelines, and OPPS billing regulations when assessing accounts to identify unbundling of charges & medical necessity issues
  • Participate in special rebilling projects and performs other duties as required or assigned.
  • Can be remote or hybrid
Requirements:
  • Proficient in Epic Billing and  ICD-10 diagnosis coding guidelines, CPT/HCPCS code assignment
  • Working knowledge of the Outpatient Prospective Payment System (OPPS)
  • Adept at comparing documentation, code assignment and charge for accuracy and completeness and elevating concerns to manager
  • Ability to establish and maintain effective working relationships as required by the duties of the position
  • Ability to concentrate and accomplish tasks with explicit accuracy
  • Functional knowledge of facility EMR, encoder, and other support software
  • 5-7 years of multispecialty coding experience in AmSurg and/or clinic settings
  • Bachelor’s degree or equivalent work experience required
  • Required: AHIMA (CCS) or AAPC (CPC) approved credential
Salary: The posted salary range is not a guarantee. The actual salary will be based on qualifications, experience, and education and could fall outside of this range. Contact us for more information.
If you are passionate about what you could accomplish in this role, we would love to hear from you! 

#LI-DNI

Meet Your Recruiter

Fran Philips
Vice President, Healthcare Recruitment

Fran is a seasoned recruiter who joined Tal in 2008, after a long career in medical billing for multi-specialty practices including dermatology, dental, and ophthalmology. 

Learn more about Fran, Tal Healthcare Employee Biography

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