The Clinical Coding Analyst is accountable for the clinical review and interpretation of various codes such as but not limited to CPT-4, HCPC and ICD-10 codes for use in health plan operations and systems. The role supports the assignment of CPT and HCPCS codes to specific projects and will ensure Healthfirst maintains regulatory compliance with CMS (Center for Medicare and Medicaid Services), New York State Department of Health, and other nationally recognized coding entities' requirements.
Duties/Responsibilities:
- Review and interpret various codes, such as, but not limited to CPT-4, HCPC and ICD-10 codes and advise on systems workflow, the needed decision making, and update accountable stakeholders
- Perform coding quality checks in relation to Healthfirst policy
- Identify and determine code appropriateness, inclusion and relevance of services and their codes as they pertain to payment policy and other initiatives
- Monitor State and CMS coding and coverage notifications and ensure internal tools, resources, systems, and users are notified to ensure all necessary changes are completed
- Apply knowledge of industry standards and established rules, regulations and guidelines of coding and billing practices for both professional and facility claims to respond to cross-departmental and Line of Business (LOB) inquiries and needs
- Monitor compliance of code utilization via policies, procedures, development of relevant reports and audits
- Prepare reports, charts, and summaries for project presentation to internal stakeholders
- Provide expertise and guidance on proper coding practices as they relate to benefit development, workflow development, and quality initiatives
- Assist with the annual review of payment policies for Medicare and Medicaid LOB making changes as required with industry and coding changes
- Perform other related tasks as required or assigned
Minimum Qualifications:
- Associate degree from an accredited college or university
- Licensed Registered Nurse or foreign-trained medical school graduate
- Current Registered Health Information Technologies (RHIT) or coding certification from either American Academy of Professional Coders (AAPC), Certified Professional Coders (CPC), or American Health Information Management Association (AHIMA)
- Medical Coding experience with CPT-4, HCPC, and ICD-10 applying coding guidelines on medical specialties
- Experience with physician and facility coding and billing of services
- Up-to-date knowledge of healthcare regulatory, coding mandates and OIG work plan
- Experience using Microsoft Excel including but not limited to conditional formatting, function usage, charting, Pivot tables and reporting skills
- Knowledge of the health care delivery system
- Experience using CMS website for correct coding, billing manuals, NCD/LCD, articles, and bulletins
Preferred Qualifications:
- Experience using NY Medicaid website for billing, policies, bulletins, and contract applicability
- Experience in Health Insurance/Claims Processing and/or Utilization Review
- Knowledge of state and federal laws and regulations, including CMS and NYS requirements
- Knowledge/experience with computer processing systems and databases
- Time management, critical/creative thinking, communication, and problem-solving skills
Compliance & Regulatory Responsibilities: See Above
License/Certification: See Above
WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.
If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to careers@Healthfirst.org or calling 212-519-1798 . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within Healthfirst Management Services will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with Healthfirst Management Services.
EEO Law Poster and Supplement
All hiring and recruitment at Healthfirst is transacted with a valid "@healthfirst.org" email address only or from a recruitment firm representing our Company. Any recruitment firm representing Healthfirst will readily provide you with the name and contact information of the recruiting professional representing the opportunity you are inquiring about. If you receive a communication from a sender whose domain is not @healthfirst.org, or not one of our recruitment partners, please be aware that those communications are not coming from or authorized by Healthfirst. Healthfirst will never ask you for money during the recruitment or onboarding process.
Hiring Range:
- Greater New York City Area (NY, NJ, CT residents): $79,300 - $114,580
- All Other Locations (within approved locations): $69,800 - $103,870
As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision.
In addition to your salary, Healthfirst offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live.
The hiring range is defined as the lowest and highest salaries that Healthfirst in "good faith" would pay to a new hire, or for a job promotion, or transfer into this role.