MEDICAL AUDIT ANALYST

The Medical Coding Analyst is responsible for the resolution of complex coding denials while also supporting the billing team by reviewing the coding of claims (i.e. ICD-10, CPT-4, etc.) and/or auditing medical charts to ensure that data is complete and supports codes assigned for optimal reimbursement and in compliance with Federal, State and private industry mandates.

The Medical Coding Analyst will also provide analysis identifying trends with root causation and identification of areas of opportunity for provider education while implementing stringent tracking measurements for outcomes. Responsible for the training and monitoring, through Quality Reviews, the staff as well as on-boarding new hires.

Job Responsibilities

- Resolve Coding Related denials through thorough review of Medical Records to support the billing of various types of services such as E/Ms, Diagnostic Tests, Laboratory, Pathology, Office Procedures, Surgeries, Anesthesia, etc.

- Conduct Audits on Down Coded E/M services

- Conduct Audits and submit supporting documentation in response to Medicare RAC Audits

- Conduct Quality Assurance Reviews on Corrected Claims and Coding Denial Appeals

- Creates/Maintains trackers as necessary for Audits and/or Projects to track and report on outcomes

- Assists in educating the billing staff with accurate and appropriate assignment of ICD-10, CPT/HCPCS, and modifiers for the purposes of billing to ensure maximum reimbursement while also ensuring compliance with regulatory and payer guidelines

- Assist in research and other analytical projects such as evaluating billing and coding practices within departments to ensure compliance and/or identify enhanced revenue opportunities

- Assist in researching CMS, Medicaid, and Payor Guidelines to ensure adherence to correct Coding  and Billing Principles surrounding Payor Policies

- Analysis of Coding related denials to identify root cause and areas of opportunity for provider education/training

Qualifications

- Associates Degree Required; Bachelor’s Preferred

- CPC Certification Required

- Must maintain their annual credits mandated by the AAPC

- Trained in ICD-10, HCPC, and CPT-4 coding

- Advanced proficiency with research and problem-solving skills as it relates to Coding required

- Ability to identify trends and report findings in a clear and concise fashion a must

- Comprehensive knowledge and experience with Provider Based Billing a plus

- Proficiency with CMS, Medicaid, and Payor Guidelines as it relates to Coding and Billing Principles

- Strong Knowledge of Medical Billing a must

- EPIC PB Resolute preferred

- EXCEL proficiency preferred

Department: Professional Services Bargaining Unit: Non Union Campus: YONKERS  Employment Status: Regular Full-Time Address: 3 Executive Boulevard, Yonkers
Shift: Day Scheduled Hours: 8:30 AM-5 PM Req ID: 214294 Salary Range/Pay Rate: $62,400.00 - $71,500.00    

For positions that have only a rate listed, the displayed rate is the hiring rate but could be subject to change based on shift differential, experience, education or other relevant factors.

To learn more about the “Montefiore Difference” – who we are at Montefiore and all that we have to offer our associates, please click here.  

Diversity, equity and inclusion are core values of Montefiore. We are committed to recruiting and creating an environment in which associates feel empowered to thrive and be their authentic selves through our inclusive culture. We welcome your interest and invite you to join us.

Montefiore is an equal employment opportunity employer. Montefiore will recruit, hire, train, transfer, promote, layoff and discharge associates in all job classifications without regard to their race, color, religion, creed, national origin, alienage or citizenship status, age, gender, actual or presumed disability, history of disability, sexual orientation, gender identity, gender expression, genetic predisposition or carrier status, pregnancy, military status, marital status, or partnership status, or any other characteristic protected by law. 

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