The Medical Compliance Specialist assist with ensuring that the clinical needs of individuals served are being met and maintained as per all state and federal regulations and in accordance with agency policy. This person will support new and existing Managers/Directors by completing regular audits of medical and other records to ensure compliance and assisting with the ne

Associate, CPC Outpatient Auditor Burlington Office, 62 Merchants Row, Williston, Vermont, United States of America Fishkill Office, 300 Westage Business Center Drive, Fishkill, New York, United States of America Headquarters Office, 625 State Street, Schenectady, New York, United States of America Rochester Office, 220 Alexander Street, Rochester, New York, United States

Responsible for the tracking, coordination and communication of patient referrals in work queue. Collaborate with Practices to ensure complete and accurate patient registration, including demographics and current insurance. Assembles information concerning patient's clinical background in EPIC to help with referral. Contacts insurance companies to ensure verification of b

1. Accurately prepares patient documentation for batch scanning into electronic record system. 1.1 Prepares patient documentation for scanning according to the date of discharge, or other criteria communicated by department leaders. 2. Scans documents into electronic document management system using a batch scanner. 2.1 Operates batch management software and batch scanner

1. Reviews medical record documentation to determine appropriate ICD 10 CM codes in accordance with official coding guidelines. 2. Reviews medical record documentation and accurately selects the appropriate CPT codes, modifiers, and ICD 10 PCS, when applicable, in accordance with official coding guidelines. This includes resolving CCI edits, as applicable. 3. Maintains a

1. Manages in collaboration with the OP Coding Leadership team the day to day activities related to Outpatient Coding AR to ensure accuracy, completeness, and timeliness of coding completion. This includes, but is not limited to ongoing communication and collaboration with internal and partner departments to resolve outstanding issues and streamline workflows, monitoring

1. Screens and refers incoming phone calls and directs patients and families to ensure that accurate and timely department communication is facilitated and that the Department is represented in a positive manner. 1.1 Provides all support and clerical assistance to patients, families, staff (both departmental and hospital), and community contacts with the greatest consider

Performs coding services while meeting daily production and quality goals Performs audit activities including review of medical chart coding and billing documentation Partners with providers and staff to improve quality and efficiencies in coding and documentation of provider claims which involves educating and coaching on compliant coding practices Maintains excellent do

1. Researches payer denials related to medical necessity, coding, etc resulting in denials and delays in payment. 2. Evaluates Outpatient Clinical denials against medical record documentation, the coding of the encounter , payer policies and contracts, and coverage determinations to determine the viability of an appeal 3. Compiles the supporting documentation by working i

At Stony Brook Medicine, the Coding Specialist will be responsible for selecting and assigning accurate codes from the current version of coding systems including ICD 10 CM, ICD 10 PCS, CPT and HCPCS codes. Duties of a Medical Record Coder may include the following but are not limited to Assign ICD 10 CM/PCS, CPT and HCPCS codes with modifiers for services provided in the

Job Description PT 22.5 11a 7p Facilitates the registration of Outpatient Patients. Interviews patient and/or representatives to obtain identifying information and other data required for registration Job Responsibility 1. Receives in coming telephone calls promptly and professionally. 2. Maintains constant awareness of patient arrival. 3. Monitors prescriptions for expir

1. Follows department established Fax Review protocols. Extracts and summarizes pertinent clinical information to transmit to payors for reimbursement. 2. Proactively identifies potential concerns regarding clinical eligibility for admission and/or continued stay reviews and addresses with Care Coordination. 3. Coordinates reconsiderations and/or peer to peer reviews for

1. Analyze and document all problems and resolutions to HVC Procedural services charging process 2. Develops and maintains a working knowledge of CPT coding, ICD 9/10 coding, DRG's and revenue contracts to ensure proper and effective charge capture is accomplished in HVC Procedural Services. 3. Develops working knowledge of all standard Hospital software products related

1. Assisting in the ongoing updates of CPT and ICD10 Notifying physicians of changes within each specialty; evaluating procedure codes and diagnosis on an ongoing basis and recommending corrections and changes for continuous improvement; Reviewing coding guidelines for OP reports, Multi Specialty Surgeons, Physician Assistants, hospitalists and other departments; attendin

1. Collects, validates and accurately documents patient insurance and benefits information and is fully knowledgeable about all aspects of insurance verification requirements. 1.1 Utilizes the On line Eligibility system and/or other means (i.e. telephone, fax or various third party payer website) to obtain insurance benefits and makes sure insurance verification informati