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Reimbursement Specialist

1 month ago


New York, New York, United States Tal Healthcare Full time
{"Job Title": "Reimbursement Analyst", "Job Description": "Key Responsibilities
  • Resolve coding-related errors and denials identified by CDM edits or the Billing Department.
  • Review documentation associated with accounts in Epic work queues to determine the appropriate charge, procedure, and/or diagnosis codes.
  • Liaise with the front end as needed to ensure that visits are registered correctly.
  • Ensure that documentation supports charges on claims to prevent denials/underpayments and adhere to compliance standards and credible coding sources.
  • Assist the PFS with analyzing coding denials and writing appeals as needed.
  • Review and distribute coding-related articles to clinical staff, including medical necessity policies and coding/billing information for various procedures.
  • Research and identify missing device and/or drug-related charges required to support procedures on claims and bring to the manager's attention for follow-up.
  • Identify and assist with documentation gaps in retrospect of CMS, AHA, or AMA guidelines for revenue enhancement opportunities.
  • Identify patterns, trends, and opportunities for charge capture and revenue enhancement.
  • Update charges in Eagle as required by posting and deleting and ensure that the correct information is entered to avoid negative charges or incorrect DOS.
  • Assist with special projects related to re-billing or charge master activities.
  • Participate in education programs to maintain up-to-date coding skills.
Requirements
  • Proficient in Epic Billing and have a thorough working knowledge of ICD-10 diagnosis coding guidelines, CPT/HCPCS code assignments.
  • Knowledge of the Outpatient Prospective Payment System (OPPS).
  • Detailed knowledge and understanding of hospital vs. professional charging and coding.
  • Ability to concentrate and accomplish tasks with explicit accuracy and established/maintained effective working relationships as required by the duties of the position.
  • Functional knowledge of facility EMR, encoder, and other support software.
  • 3-5 years of multispecialty coding experience in AmSurg and/or clinic settings.
  • Bachelor's degree or equivalent work experience required.
  • AHIMA (CCS) or AAPC (CPC) approved credential.
About the Role

This is a unique opportunity to join Tal Healthcare as a Reimbursement Analyst. As a key member of our team, you will be responsible for resolving coding-related errors and denials, reviewing documentation, and ensuring compliance with coding standards.

If you are passionate about healthcare and have a strong background in coding and billing, we encourage you to apply for this exciting opportunity.

Contact us for more information about this role and how you can contribute to our team's success.

", "lang_code": "en"}