Medical Coding and Billing Assistant 2

Working at Yale means contributing to a better tomorrow. Whether you are a current resident of our New Haven-based community, eligible for opportunities through the New Haven Hiring Initiative, or a newcomer, interested in exploring all that Yale has to offer, your talents and contributions are welcome. Discover your opportunities at Yale!

Overview

The Medical Coding and Billing Assistant 2 is responsible for accurate charge submission for patient clinical services based on coding, documentation review, quality assurance, and compliance guidelines. This role requires comprehensive knowledge of coding systems, documentation guidelines, and compliance with Federal payer regulations and HIPAA guidelines. The position involves maintaining effective workflow processes, ensuring timely billing, and optimizing reimbursements. The assistant must exercise independent judgment and decision-making while ensuring compliance with established protocols and maintaining productivity standards.

This role typically operates in a remote (work from home) environment within Connecticut.

Required Skills and Abilities

1. Demonstrated ability to apply critical thinking skills with comprehensive knowledge of ICD-10, CPT, HCPCs, modifier coding, medical terminology, human anatomy, and digital coding resources/software. Ability to analyze and interpret evaluation and management documentation guidelines, surgical procedure reports, diagnostic studies, pathology, and labs. Certified Professional Coder (CPC) through AAPC organization and must maintain certification through annual education requirements.

2. Proficiency with electronic health record and practice application systems, electronic data entry and retrieval, and web-based applications and websites. Intermediate proficiency with MS Word, Excel, Outlook (emails and calendars), Zoom, and PowerPoint.

3. Demonstrated ability to independently perform all categories of coding/billing work, including surgical coding, with comprehensive knowledge of Federal payer regulations, third party payers, HIPAA rules, reimbursement policies, and Teaching Physician Guidelines within an academic medical practice. Proven ability to interpret and apply guidelines.

4. Demonstrated ability to train others and assist in the QA process across multiple service lines. Strong interpersonal, verbal, and written communication skills.

5. Ability to work independently with a high level of proficiency, accountability, and productivity, while organizing and prioritizing work with minimal supervision. Ability to work in a fast-paced environment meeting timely deadlines and maintaining high productivity and quality standards. Ability to work effectively as a team member with common goals.

Preferred Skills and Abilities

1. Additional specialty coding credential.

Principal Responsibilities

1. Acts as an expert resource on proper procedural and diagnostic coding and changes in codes and coding practices as they reflect changes in medical practices.  Based on a high level of medical knowledge of human anatomy and physiology in specialized medical fields and procedures, reviews and revises the coding of medical professionals, including physicians and APPs.  Advises medical professionals and D-level Coding Specialists in order to ensure accuracy of coding and reimbursement of claims and compliance with government regulations and third-party carrier requirements.  
2. Reviews operative and diagnostic reports, as well as procedures and E&M service documentation to validate diagnostic (ICD-10) and procedural (CPT/HCPCS) codes and modifiers with consideration given to charge review edits within work queues for Yale Medicine patient clinical services.  Expert resource within the Epic Professional Billing application, ensuring that all charge review edits are appropriately resolved in charge review work queues to file clean, accurate claims, utilizing claim judgement and critical thinking skills.  
3. Follows charge reconciliation processes to ensure all charges are being captured for all providers.  Verifies all information required to produce and submit a clean claim including provider, place of service, date of service, bill area, all codes and special billing procedures that may be defined by a payer, contract, or YMA.  Ensure compliance with Teaching Physician guidelines within an academic medical practice.
4. Pends charge sessions to seek corrective action for services not me…