Billing Compliance Specialist

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* As required under NYC Human Rights Law Int  - Salary range for this role when Hired for NYC Offices

Monitors physician billing activity for compliance and audit feedback processes.

• Tracks and trends results of audits. Prepares and presents reports on results.
• Analyzes physician coding patterns and other documentation utilizing electronic databases.
• Assists in orienting new employees/faculty to departmental billing and compliance policies and procedures and notifies new employees/faculty of upcoming compliance training workshop dates.
• Monitors coding and medical record documentation compliance with federal and state regulations. Educates clinical staff and providers on compliant coding for maximum revenue.
• Designs audit tools and methodology for conducting audits. Conducts prospective and retrospective compliance documentation audits. Maintains integrity of electronic and hard copy files and databases.
• Researches and educates providers on appropriate coding for provider specialty.
• Trains as necessary on coding/documentation changes implemented internally and by insurance carriers.
• Monitors effectiveness of corrective action plans.
• Evaluates current compliance plan, makes recommendations for changes, and implements and executes new policies and procedures.
• Attends workshops, seminars and/or conferences to keep abreast of standards and best practices within the field. Disseminates information to colleagues and/or staff as appropriate.
• Identifies trends in revenue cycle activities, including payments, denials, billing, coding and/or documentation errors. Recommends actions plans to address deficiencies. Monitors implementation of corrective action plans.

• Bachelor's Degree in related field

Approximately 2-3 years of experience in medical records and/or physician billing

Approximately 1-2 years of experience as medical coder

• Demonstrated knowledge of professional billing, including physician billing, reimbursement, and carrier relations.
• Demonstrated knowledge of third party reimbursement.

• Certified Professional Coder Certificate (CPC)

Standard office work

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