Coding and Billing Analyst

Job Title

Working at Yale means contributing to a better tomorrow. Whether you are a current resident of our New Haven-based community- eligible for opportunities through the New Haven Hiring Initiative or a newcomer, interested in exploring all that Yale has to offer, your talents and contributions are welcome. Discover your opportunities at Yale!

Salary Range: $68,000.00 - $120,500.00

Overview

Under the direction and supervision of the Manager of YM Coding and Billing services or his/her designee, this position is responsible for processes to monitor the efficiency and accuracy of capturing, coding and processing all billable services for YM. Document, implement and monitor policies and operational workflows to streamline and optimize charge capture, ensuring accuracy and timeliness. Develop and monitor reports to assure compliance with established YM guidelines. Serves as a liaison and fosters collaboration among the clinical departments, revenue cycle services and compliance departments on all aspects of coding and billing, education and charge follow-up. Serves as expert resource for coders.

Required Skills and Abilities

1. Current CPC certification required. Knowledge of CPT, ICD-10, HCPCS codes, medical terminology, and HIPPA regulations. Experience with an electronic health record and practice application systems, electronic data entry, and web-based applications and websites. Expert proficiency with MS Word, Excel, PowerPoint, and Outlook (emails and calendars).

2. Knowledge of medical insurance billing procedures, third-party reimbursement methodologies and documentation/compliance requirements, government and commercial insurance rules and regulations pertaining to correct coding initiatives.

3. Well-developed problem-solving skills with the ability to be innovative, ability to compile comprehensive analysis of data with complex and professional reporting of results, analyze and interpret detailed reports, develop clear conclusions and summarize findings.

4. Demonstrated ability to work independently as well as part of a cross-functional team to plan, research and conduct projects as well as manage timelines and work to achieve common goals.

5. Well-developed interpersonal, and oral and written communication skills demonstrating a high degree of professionalism, diplomacy and accountability.

Principal Responsibilities

1. Regularly reviews billing activity or specific clinical departments or sections. Provides comprehensive, detailed summary of findings (payment history, rejection analysis, frequency and status of unpaid claims, etc.). Communicates and provides regular updates to administration, physicians and coders.

2. Provides advice on operational improvement to enhance efficiency of payment and overall reimbursement of clinical services.

3. Develops, implements, and monitors policies and procedures to optimize provider reimbursement. Functions as a resource and educator for clinical department physicians and all appropriate staff on billing and coding issues by department.

4. Develops training or educational programs and working manuals on procedural guidelines and implementation of new regulatory standards and initiates changes as contracts and regulations change.

5. Collaboratively establishes policies and procedures to resolve issues around claims that are rejected, nor responded to, underpaid, etc. Provides recommendations on how to reduce rejections to improve collections.

6. Researches policies of payers and communicates changes as appropriate. Maintains regular interactions and communication with third party payers.

7. Leads and/or assists with the management and/or performance of ongoing reimbursement projects, including but not limited to in depth analysis of variances and tracking/managing issues with carriers.

8. Performs coding audits, assesses risk and communicates findings.

9. Ensures compliance with University, governmental and all third party regulations, including claim submission, coding accuracy and documentation to support billing. Performs quality assurance processing and assesses degree of risk for non-compliance with internal audit findings.

10. Manages and coordinates decisions on optimizing output of subordinates and colleagues in producing information.

11. May manage staff of both exempt and non-exempt employees.

12. May perform other duties as assigned.

Required Education and Experience: Bachelor's Degree in Health Care Administration or RN and five years of related work experience or an equivalent combination of education and experience.