Who we are: Children’s Aid (CA) is an independent, not-for-profit organization established to serve the children of New York City. Children’s Aid serves New York's neediest children and their families at more than 50 locations in New York City and Westchester County. What you will be doing: As a key member of our Health and Wellness team reporting to the Supervisor of Billing and Revenue, you will be responsible for reviewing progress notes, accurately coding claims for submission to Medicaid, Medicaid Managed Care and commercial insurance providers, reviewing claims payments and denials with the goal of maximizing claims reimbursement.
- Evaluates medical and related documentation to ensure diagnostic and procedural codes accurately reflect and support the patient encounter and comply with regulatory standards. Works with provider to adjust as required.
- Reviews medical documentation for accuracy and completeness.
- Interprets medical records and accurately assigns appropriate and correct ICD-10 and CPT codes.
- Performs periodic Quality Assurance audits. Reports results and takes action as necessary.
- Maintains metrics on clean claims, denials, re-submissions and other measurement standards and submits for management review.
- Develops and updates procedures manuals for maintaining current and correct coding, minimizing the risk of fraud and abuse, and optimizing revenue recovery.
- Stays abreast of current medical coding and billing issues, trends, and changes in the laws and regulations. Makes recommendations for changes in policies and procedures.
- Bachelor's degree or equivalent combination of education and experience
- Current coding certification (CPC or CCS) required
- 5 years of Medical Billing/Coding and revenue cycle management experience; Pediatrics preferred
- Knowledge of: ICD-10 and CPT coding guidelines; medical terminology.
- Must have Electronic Health Record (EHR) and/or practice management software experience; eClinicalWorks (eCW) preferred.
- Knowledge and understanding of:
- Medicaid and Medicaid Manage Care reimbursement guidelines
- Medical insurances policies and procedures
- EDI institutional and professional claims formats, denial management, appeals
- Reimbursement systems, regulations and polices pertaining to coding, billing and documentation.
- Ability to research and analyze data and resolve issues; read, interpret and apply policies, procedures, laws, and regulations, read and interpret medical procedures and terminology
- Strong customer service skills.
Minimum Education Required
How To Apply
Please apply online through Children’s Aid website – Job ID: 002942
Children's Aid is an Equal Opportunity Employer and does not discriminate on the basis of race, color, religion, national origin, gender, sexual orientation, age, marital status or disability