Job Summary:

Analyze OP admits for appropriate billing requirements involving Advanced Beneficiary Requirement (ABN) waivers, pre-authorizations, referrals, correct insurance demographic information and medical necessity pertaining to documentation and coding. Will interact with referring physicians, patients, hospital and MSG staff ensuring quality demographic and clinical information is obtained at the time of scheduling or prior to when the exam is ordered. Assist with pre-authorization as needed and coordinate any pre-registration requirements with Patient Access Services. Conduct ongoing internal audits and maintain all documentation. Review and analyze insurance denials, identifying problem areas and recommending and coordinating corrective actions. Review orders for appropriate clinical indications and provide ICD-10 coding. Monitor new billing/compliance regulations for both the Hospital and MSG to determine the impact on operations and charging issues.

Minimum Qualifications:

Associates degree and 2 years relevant experience in an administrative role or equivalent combination of education and experience may be considered. Additional course work or specialized training pertaining to Medical Terminology, Medical Coding, Medical Assistant Program.

Preferred Qualifications:

Certified Professional Coder (CPC) /Certified Coding Specialist (CCS) also preferred. Extensive knowledge of billing requirements according to payer; working knowledge of ICD-10, CPT-2020 coding principles and medical terminology preferred.

Work Days:

40 hrs/week Monday-Friday; Specific hours to be determined. May be required to work overtime based on departmental needs.

Message to Applicants:

Recruitment Office: Human Resources