Medical Coder & Billing Specialist

POSITION SUMMARY

This position will be responsible for performing on-going auditing of outpatient provider coding, and education. Individuals must be a certified coder, with experience in NY Medicaid regulations.

The Senior Coding & Billing Specialist is responsible for auditing outpatient provider coding and documentation to ensure accurate code assignment, regulatory compliance, and optimal reimbursement. This position serves as a subject matter expert in CPT, ICD-10-CM, HCPCS, New York State Medicaid, CMS, and commercial payer requirements, ensuring services are coded and billed accurately in accordance with applicable federal, state, and payer guidelines.

In addition to coding audits, this role is responsible for reviewing and resolving billing work queues, analyzing claim denials and reimbursement trends, identifying charge capture and documentation opportunities, and supporting timely claim resolution. The Senior Coding & Billing Specialist partners with providers, operations, finance, and revenue cycle leadership to improve documentation quality, reduce denials, optimize reimbursement, and strengthen overall revenue integrity through education, Epic optimization, auditing, and continuous process improvement.

• Identify provider documentation improvement opportunities through coding audits and collaborate with providers and clinical leadership to enhance documentation quality and optimize reimbursement.
• Identify coding, billing, charge capture, and documentation issues impacting reimbursement and provide recommendations for corrective actions to the VP of Revenue Cycle.
• Identify coding-related payer denials and collaborate with appropriate stakeholders to reduce denials and improve coding accuracy.
• Maintain current knowledge of CPT, ICD-10-CM, HCPCS, CMS, New York State Medicaid, and commercial payer coding requirements and educate providers and staff in regulatory updates.
• Analyze trends in provider documentation, coding accuracy, and missed coding opportunities, and develop professional educational materials and recommendations for providers.
• Collaborate with third-party revenue cycle vendors to identify coding issues and opportunities and develop remediation plans.
• Recommend Epic automation, Smart Sets, documentation templates, hard stops, soft stops, and workflow enhancements to improve coding accuracy, documentation compliance, and reimbursement.
• Perform other duties and special projects as assigned.

• Work assigned Epic billing work queues (WQs) to timely resolution, ensuring accurate claim submission and reimbursement.
• Identify Epic billing work queue issues and collaborate with Revenue Cycle leadership to develop and implement corrective action plans and workflow improvements.
• Identify billing edits, charge capture, pricing discrepancies, claim rejections, and reimbursement issues, and recommend corrective actions to optimize revenue.
• Perform billing and reimbursement audits utilizing Epic Slicer Dicer  and various other reporting tools, and advanced Microsoft Excel functions, including Pivot Tables to ensure compliant billing and accurate reimbursement.
• Maintain current knowledge of New York State Medicaid, CMS, and commercial payer billing regulations, reimbursement methodologies, and payer contract requirements, and communicate updates to appropriate stakeholders.
• Monitor billing work queues, denial trends, and timely filing requirements to improve first-pass claim acceptance and reduce revenue leakage.
• Collaborate with the VP of Revenue Cycle Operations and Optimization to resolve complex billing and reimbursement issues.
• Identify opportunities for Epic billing automation, workflow optimization, and process improvement to enhance operational efficiency and reimbursement.
• Participate in revenue cycle initiatives, system testing, and special projects as assigned.

• Develop and provide ongoing education for current and new providers regarding coding accuracy, documentation requirements, reimbursement, and regulatory compliance.
• Evaluate the results of internal and external coding…