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About the Role

This position provides audit and research support for physicians, advanced practice professionals, professional fee billing staff, clinic staff, administrators, and other personnel on documentation and billing requirements. It determines the adequacy of medical records documentation, coding, and billing across all clinical specialties using established auditing and research techniques. The role involves reading, interpreting, and distributing coding and billing guidelines to ensure regulatory compliance.

Responsibilities

Exemplifies AMHS Values and Code of Conduct, identifying compliance risks through review of RAC Audit requests, ensuring timely appeals, and reporting risks to Legal Services and Corporate Compliance.
Ensures immediate action on issues identified by Legal Services or Corporate Compliance.
Builds collaborative relationships with AMHS executive team, clinical chairs, faculty, clinicians, and leaders, promoting integration of new processes.
Reviews clinical documentation and charges in response to edits and/or inquiries from third-party payers.
Resolves edits based on regulatory and/or payer-specific guidelines.
Generates appeal letters for denials and updates patient accounting system.
Collaborates with revenue cycle, information systems, and clinical departments to ensure charge accuracy.
Performs audits on patient accounts and tracks results.
Engages in end-to-end testing for new charge generation and revisions.
Reviews clinical documentation and validates/adds charges to patient encounters.
Researches and answers billing and documentation questions to ensure compliance with payer regulations.
Reviews documentation or coding patterns posing a compliance risk and provides solutions.
Stays current with third-party regulations, including Medicare billing, teaching physician regulations, CPT, ICD-10-CM Coding, and professional fee billing.
Serves as a reference for regulatory, reimbursement, or billing changes and develops/implements training.
Maintains knowledge of revenue cycle processes to aid in implementing regulatory standards for compliant charge capture.
Monitors compliance with corporate, federal, and state guidelines, including HCPCS/CPT code changes and billing unit rule changes.
Performs other duties as assigned.

Requirements

Associate's Degree in a health care-related or business-related field required.
Two years of experience in auditing, compliance, and/or coding required.
RHIT, RHIA, CCS, or CPC required.
Knowledge of third-party billing regulations for hospital and/or provider reimbursement.
Experience and understanding of the CPT coding system.
Knowledge of medical necessity edits related to local and national coverage determinations (LCDs and NCDs), correct clinical initiatives (CCI), and medically unlikely edits (MUEs).
Strong clinical knowledge and clinical documentation practices.
Excellent verbal and written communication skills.
Experience with navigating within the electronic medical record.
Strong critical thinking skills.
Detail-oriented with the ability to prioritize multiple tasks/projects with varying deadlines.
Engaged and collaborative team player.
Experience utilizing MS Office products.
Equivalent combination of relevant education and experience may be substituted as appropriate.

Skills

Epic experience preferred
Experience with Epic preferred
Registered Nurse (RN) preferred
Bachelor's Degree in nursing preferred
Minimum of three years' experience in a clinical setting preferred

Location

Day (United States of America)

Work Type

Experience Level

Two years of experience in auditing, compliance and/or coding - required
Minimum of three years' experience in a clinical setting - preferred

Education Level

Associate's Degree in health care-related or business-related field - required
Bachelor's Degree in nursing - preferred
RHIT, RHIA, CCS, or CPC - required
Registered Nurse (RN) - preferred

Salary/Compensations

$70,068.00 - $108,605.00

About the Company

Albany Medical Center is an equal opportunity employer.
This role may require access to information considered sensitive to Albany Medical Center, its patients, affiliates, and partners, including but not limited to HIPAA Protected Health Information and other information regulated by Federal and New York State statutes. Workforce members are expected to ensure that: Access to information is based on a “need to know” and is the minimum necessary to properly perform assigned duties. Use or disclosure shall not exceed the minimum amount of information needed to accomplish an intended purpose. Reasonable efforts, consistent with Albany Medical Center policies and standards, shall be made to ensure that information is adequately protected from unauthorized access and modification.
Albany Med Health System is an equal opportunity employer.
This role may require access to information considered sensitive to Albany Med Health System, its patients, affiliates, and partners, including but not limited to HIPAA Protected Health Information and other information regulated by Federal and New York State statutes. Workforce members are expected to ensure that: Access to information is based on a “need to know” and is the minimum necessary to properly perform assigned duties. Use or disclosure shall not exceed the minimum amount of information needed to accomplish an intended purpose. Reasonable efforts, consistent with Albany Med Health System policies and standards, shall be made to ensure that information is adequately protected from unauthorized access and modification.

Equal Opportunity

Albany Medical Center is an equal opportunity employer.
Albany Med Health System is an equal opportunity employer.