MEDICAL CODING AND BILLING ANALYST

Job Purpose Responsible for supervising, evaluating, and consistently improving the day-to-day operations of Medical Practice. This role is responsible for accurate and timely billing of insurance claims and patient statements across multiple sites, implements accurate medical coding policies, and enhances operational processes. It involves acting as a liaison between coding operations and clinical staff, training and coaching medical personnel on coding guidelines, and ensuring the accuracy and timeliness of clinical documentation. Additionally, the role includes analyzing and optimizing diagnosis data submission processes, presenting performance results to leadership, and supporting HCC/RAF optimization strategies. The role will also oversee the training of Medical Practice Assistants, Physician and IDT disciplines in ICD-9/ICD-10 guidelines. Job Responsibilities Deliver accurate and timely billing of insurance claims and patient statements for all sites (12 sites around NYC) as well as other entities within the organization. Review coding and billing process for operational enhancements; implement accurate medical/coding policies and Claims Manager edits across all PACE sites and other entities. Research and perform changes and additions to procedure master, fee schedules, diagnosis tables, and modifier tables to ensure accurate reporting of procedures. Act as liaison between medical coding/revenue cycle operations and the clinical physicians/staff. Assist in new hire orientation of Medical Practice and Medical Records staff; train and coach physicians and IDT disciplines regarding coding policies. Establish and monitor a system for on-site and off-site storage, access, and protection of active and discharged medical records. Assure accuracy and timeliness of clinical documentation in Medical Records and/or Electronic medical record solution. Provide training and perform chart audits for proper documentation and ensure accuracy of diagnostic coding medical documentation. Determine coding for new and existing patients and act as a resource for coding and related areas for Center Light Healthcare System. Work with Site Medical Director/Attending Physician and Nursing in QA review of their respective disciplines as they relate to the Practice’s overall activities. Ensure that all services/disciplines in the Practice provide coordinated care and excellent communication with all disciplines at CenterLight Healthcare in a timely manner. Cover for staff or find temporary coverage as needed. Attend Medical Practice meetings and arrange own staff meetings on a regular basis. Analyze and monitor coding processes to ensure accurate diagnosis data has been submitted to Claims and CMS. Evaluate and enhance the diagnoses data submission process to CMS, proposing innovative approaches to create or improve automation and optimize processes where appropriate. Review and analyze monthly financial reports submitted by Medicare related to diagnostic data. Present HCC/RAF performance results and findings regularly to key internal leadership. Propose opportunities to maximize reimbursement based on CMS‑HCC Model and Methodology. Make recommendations to clinical staff on how best to support the HCC/RAF optimization strategies. Monitor individual physician and clinic performance for key HCCs and diagnoses, provide leading indicator data and standard reports to the physician practices on current performance. Serve as subject matter expert on Risk Adjustment Data Validation (RADV) audits from Medicare. Perform random audits of coding submissions by outside vendors. Other duties as assigned. Schedule 8:30 AM – 5:30 PM (40 weekly hours) Education College degree required. Certifications Must have at least one of the following certifications with an active status by the American Association of Professional Coders (AAPC) or American Health Information Management Association (AHIMA): Certified Professional Coder (CPC) Certified Professional Medical Auditor (CPMA) Certified Professional Practice Manager (CPPM) Certified Professional Biller (CPB) Certified Risk Adjustment Coder (CRC) Experience Three (3) years’ experience in medical coding/medical billing is required. Working knowledge of Medicare and Medicaid is required. Available to travel around all PACE sites on a regular basis. Attention to detail, critical thinking, time management skills, and a sense of urgency. Strong interpersonal and communication skills with the ability to work collaboratively across departments. Knowledge of healthcare regulations (e.g., HIPAA, CMS, etc.) and a commitment to patient data privacy and security. Experience with EMR software, i.e., Athena and provider portal application, i.e., Stellar Health, is strongly preferred. Proficiency with Microsoft Office Suite (Excel, Word, PowerPoint); especially Excel is required. Physical Requirements Standing – up to 6 hours a day. Sitting/Stationary positions – up to 6‑8 hours a day for consecutive periods. Lifting/Push/Pull – up to 50 pounds of equipment, baggage, supplies, and other items using OSHA guidelines. Bending/Squatting – ability to safely bend or squat to perform essential functions. Stairs/Steps/Walking/Climbing – ability to safely maneuver stairs, climb up/down, and walk to access work areas. Agility/Fine Motor Skills – ability to operate and activate equipment, devices, instruments, and tools to complete essential job functions. Sight/Visual Requirements – ability to read documentation, papers, orders, signs, etc., and type/write documentation accurately. Audio Hearing and Motor Skills – capability to listen attentively, document information from patients, community members, co‑workers, clients, providers, etc., and intake information through audio processing accurately; ability to speak comfortably and clearly. Cognitive Ability – ability to demonstrate good decision‑making, reasonableness, cognitive ability, rational processing, and analysis to satisfy essential functions of the job. Disclaimer Responsibilities and tasks outlined in this job description are not exhaustive and may change as determined by the needs of the company. Equal Opportunity Statement We are an affirmative action and equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, disability, age, sexual orientation, gender identity, national origin, veteran status, height, weight, or genetic information. We are committed to providing access, equal opportunity, and reasonable accommodation for individuals with disabilities in employment, its services, programs, and activities. Salary Range (Min‑Max) $75,000.00 – $85,000.00 #J-18808-Ljbffr C2Q Health Solutions