Revenue Cycle Specialist-Revenue Integrity - Pathology
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AI Summary
Title: Revenue Cycle Specialist-Revenue Integrity - Pathology
Location: Midtown
Org Unit: AR - Coding Surgical
Work Days:
Weekly Hours: 35.00
Exemption Status: Non-Exempt
Salary Range: $32.69 - $36.76
*As required under NYC Human Rights Law Int 1208-2018 - Salary range for this role when Hired for NYC Offices
Position Summary
Remote position – Join a team of dedicated revenue cycle professionals in the Central Business Office (CBO) of Weill Cornell Medicine (WCM). Apply your knowledge as a Certified Professional Coder (CPC) to investigate and resolve coding related insurance payment denials. Review medical records to write robust appeals defending medical necessity. The CBO partners with WCM Clinical Departments to increase and expedite service revenue, reduce aged AR, and trend denials for their root causes thereby driving efficiencies, to include clinical documentation improvement and coding denials prevention.
Job Responsibilities
- Performs retrospective coding review of denied charges for physician services.
- Reviews medical records for completeness and accuracy to ensure documentation supports the services billed and all documentation standards are met for billing.
- Make corrections to charges when necessary to match the CPT and or Diagnosis codes to the documentation as appropriate.
- Analyze for invalid denial trends, payer specific carrier submission requirements & system optimization.
- Performs extensive follow-up to investigate and resolve payment denial trends.
- Resolves outstanding accounts utilizing ancillary applications and websites as tools to retrieve medical documentation, claim status and billing guidelines to substantiate corrected claim submissions, written appeals, coding and medical necessity reviews.
- Researches and interprets payer contract terms and compiles necessary supporting documentation templates for appeals according to various payer claim guidelines.
- Ensures denial reviews are conducted in a timely manner.
- Maintains up-to-date policies and procedures and knowledge related to managed care and third party payors.
- Participates in annual and on-going mandatory compliance training. Fulfills Continuing Education Units necessary to maintain certification status.
- Assists in training current and new employees on the use of systems and departmental policies and procedures.
- Performs other related duties as assigned.
Education
- High school diploma or GED in related field
Experience
- Certification as a Certified Professional Coder (CPC) or Certified Coding Specialist (CCS).
- Should be certified by AHIMA or AAPC.
- Approximately 3-5 years of physician billing experience, specifically accounts receivable and collection experience.
- Prior experience working with an eMR system.
- Knowledge of medical terminology.
- Knowledge of third-party reimbursement.
- Microsoft Excel and other reporting software to sort, filter, summarize, and identify various accounts receivable trends.
- Pathology experience preferred
Knowledge, Skills and Abilities
- Proficient in CPT and ICD10 CM coding guidelines.
- Ability to meet productivity standards and identify any issues or trends and bring them to the attention of management.
- Demonstrated ability to function independently and exercise independent judgment.
- Demonstrated critical thinking and analytical skills.
- Ability to meet daily coding and denial management production requirements along with quality as per Company norms.
- Strong computer skills in data entry, coding, knowledge of Electronic Medical Record software (Epic), Microsoft Office, Excel.
- Ability to follow coding guidelines and legal requirements to ensure compliance with our Institutional, federal, and state regulations.
- Excellent interpersonal, verbal and communication skills.
Licenses and Certifications
- Certified Professional Coder Certificate (CPC) or Certified Coding Specialist (CCS)
Working Conditions/Physical Demands
Remote based work with rare onsite requirement. Dedicated workspace conducive to a healthy work environment.
Cornell welcomes students, faculty, and staff with diverse backgrounds from across the globe to pursue world-class education and career opportunities, to further the founding principle of “any person, any study.” No person shall be denied employment on the basis of any legally protected status or subjected to prohibited discrimination involving, but not limited to, such factors as race, ethnic or national origin, citizenship and immigration status, color, sex, pregnancy or pregnancy-related conditions, age, creed, religion, actual or perceived disability (including persons associated with such a person), arrest and/or conviction record, military or veteran status, sexual orientation, gender expression and/or identity, an individual’s genetic information, domestic violence victim status, familial status, marital status, or any other characteristic protected by applicable federal, state, or local law.
Cornell University embraces diversity in its workforce and seeks job candidates who will contribute to a climate that supports students, faculty, and staff of all identities and backgrounds. We hire based on merit, and encourage people from historically underrepresented and/or marginalized identities to apply. Consistent with federal law, Cornell engages in affirmative action in employment for qualified protected veterans as defined in the Vietnam Era Veterans’ Readjustment Assistance Act (VEVRRA) and qualified individuals with disabilities under Section 503 of the Rehabilitation Act. We also recognize a lawful preference in employment practices for Native Americans living on or near Indian reservations in accordance with applicable law.
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