Medical Coder

POSITION SUMMARY

Supports the VP of Revenue Cycle and Revenue Optimization in auditing provider clinical documentation and EM coding. Develops and presents coding and clinical documentation platform for education and training of providers. Performs Charge Audits through review of chart notes and identification of correct procedure and diagnosis codes.

ESSENTIAL JOB DUTIES AND RESPONSIBILITIES

Coding Compliance (30%)

Performs charge audit/coding review to determine appropriate ICD-10 and CPT codes to be used to report provider services to third party payers.

Review and identify accurate utilization of modifiers to ensure billing compliance and optimal reimbursement.

Identifies clinical documentation integrity opportunities to ensure coding compliance.

Drive the document strategies and messages in a collaborative way with relevant stakeholders.

Provide education and training to appropriate providers and stakeholders.

Performs other training and mentoring related duties as required.

Audit, Training and Education of Providers: (60%)

Develop an audit program for new providers, providers identified with documentation issue through the annual external coding audit and periodic reviews of problematic areas.

Develops on-going auditing and education platform to identify education and training opportunities by provider.

Recommend and work closely with EPIC hosting organization to implement automated solutions.

Collaborate with third party RCM vendor and health center operations to implement process changes.

Collaborates with cross functional teams to ensure alignment between clinical operations and PPGNY billing practices

Tracks adherence to process changes implemented and quantify financial impact.

Review changes in CPT®, HCPCS, and revenue codes for accuracy, compliance with applicable billing guidelines, and optimization of reimbursement

Education and Training (10%)

Evaluates the results of the periodic coding audits conducted by an outside agency, and partners with the VP of Revenue Cycle and Revenue Optimization and clinical services leadership to provide training and feedback to the clinical providers on their performance and areas for improvement.

Actively maintains an up-to-date knowledge base of compliant clinical documentation, coding and billing.

Maintain up to date knowledge of CMS billing rules and payer requirements to proactively identify policy changes

CORE COMPETENCIES

A demonstrated commitment to PPGNY’s mission related to bodily autonomy, health equity, gender and racial justice

A demonstrated commitment to learning about and enhancing practices related to racial equity and its impact on healthcare systems.

Strong relationship building and communication skills, including an ability to work and build trust across cultural differences related to related to race, class, age, gender, gender identity and expression, sexual orientation, religion, ethnicity, national origin or ability; and to reflect on one’s personal identity with humility.

Ability to mentor a culturally diverse team, including creating and sustaining an organizational culture that fosters inclusiveness and equity, and providing positive and developmental feedback and accountability related to practices including but not limited to equity

Ability to work collaboratively in cross-organization workgroups.

Customer service and interpersonal skills and the ability to coordinate work with others, both internally and externally, to accomplish tasks.

Engages in mutual problem solving

REQUIRED SKILLS/ABILITIES:

Interpersonal

• Excellent customer service and communication skills
• Ability to remain focused and calm in stressful situations
• Excellent interpersonal, written and verbal skills
• Ability to develop and maintain effective, professional relationships with internal and external stakeholders
• Ability to work effectively as part of team

Technical

• Proficient with Microsoft Office Suite; Advanced Excel skills including Pivot Tables and V Look Ups
• Deep understanding of EMR systems; Experience in an EPIC environment
• Strong data management and data analysis skills; research oriented with the ability to critically analyze large data sets

Subject Matter Knowledge

• In-depth knowledge of Medicare/NYS Medicaid regulations, including billing, coding, and documentation requirements.
• Experience working with a variety of commercial contracts
• Experience with principles of process improvement

Work Habits/Attributes

• Excellent organizational skills
• Outstanding time management skills, including the ability to work under deadline
• The ability to produce high quality work in a fast-paced environment.
• Ability to exercise sound judgment and independent decision-making skills
• Ability to produce reliable, high-quality work with minimal direct supervision
• Ability to exercise discretion in the handling of confidential information
• Possess strong work ethic

REQUIRED QUALIFICATIONS

• Minimum of eight years’ experience in physician/provider coding, auditing and education
• Two years’ experience with EPIC EMR

Preferred Qualifications

• Coding certification (e.g. CCS, RHIA, RHIT) or applicable experience

TYPICAL PHYSICAL DEMANDS

• Requires prolonged sitting and repetitive tasks including use of a computer. Periodic standing, walking, bending. Requires lifting or moving of up to 15 pounds. Visual acuity sufficient to perform frequent work on a computer screen and review printed reports and other materials. Requires the ability to hear and to communicate orally with others. This role routinely uses standard office equipment such as computers, phones, photocopiers, and filing cabinets, and will require reaching, grasping, pushing and pulling.

TYPICAL WORKING CONDITIONS

• This job operates in a professional office environment. Potential exposure to communicable diseases and other conditions in a health center environment. Requires flexible schedule and during peak activity periods work in excess of 7.5 hours per day and/or 37.5 hours per week.

PPGNY's benefits package includes:

Generous PTO and holiday schedule

Medical, dental and vision coverage options for you and eligible dependents

FSA, HSA, Commuter pre-tax reimbursement funds

Short- and Long-Term Disability, Free Basic Life and AD&D

401(k) Retirement Plan with Safe Harbor contributions after 1 year of employment

All positions at PPGNY require:

Proof of immunization or immunity to certain communicable diseases (including influenza during the flu season and Covid-19) and testing for tuberculosis. These certifications are required by the NYC DOHMH Health Code, NYSDOH and OSHA.

Planned Parenthood of Greater New York (PPGNY) is a leading provider, educator, and advocate of sexual and reproductive health care in New York State. PPGNY is proud to provide a wide-range of family planning services at our brick-and-mortar health centers and mobile care units. We care for everyone regardless of their immigration status, zip code or ability to pay. PPGNY’s education and outreach programs are backed by medically accurate, evidence-based information that allows people to make informed decisions about their health and future. As a voice for reproductive freedom, PPGNY supports legislation and policies that ensure all New Yorkers have access to the full range of reproductive health care and education.

At PPGNY, we provide the absolute best care to our patients and our communities through innovative health care delivery and education programming. We care for everyone who walks through our doors regardless of insurance, ability to pay or immigration status. As a leading voice for reproductive freedom, PPGNY fiercely advocates for policies to ensure that all New Yorkers will have access to the full range of reproductive health care services and information.

PPGNY is committed to diversity, equity, and inclusion. We believe we are most impactful when people with a wide range of backgrounds, experiences, and identities come together with common purpose. We encourage candidates from all backgrounds to apply.