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Coding Analyst for outpatient services Job in New York, New York

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Job Title: Coding Analyst for outpatient services

Employer:1199 SEIU Benefit Funds
Skills:proficiency in medical terminology and medical coding,advanced excel,strong math aptitude,demonstrated accountability; ability to work well in fast paced environment with competing priorities
Specialties:Working with CPT and HCPCS codes for professional and facility outpatient claims
Preferred Certifications:CDC
Required Experience:5 to 7 years
Location:330 West 42nd Street, New York 10036, NY, US
Date Posted:6/26/2018
Immediate hire at a NYC non-profit Health Plan.

* Investigate annual and quarterly cpt + hcpcs code updates for outpatient service rates and coding reimbursement policies
* Perform clinical coding reviews on an individual claim basis +/or review pended/paid claims reports. Requires analysis and interpretation of industry standard coding conventions and when indicated, review relevant medical records ( ie: unlisted codes, category III codes, etc )
* Identify claims processing irregularities, wasteful/excessive billing practices on a claim, provider +/or code level utilizing your claim experience  and judgement to determine correct coding and payment
* Conduct code/claim audits associated with our Code Editing Software on pre/post claims
*Analyze various types of  outpatient claims data and present findings and recommendations
* Manage report of either pended or paid claims in which cpt/hcpcs codes on a professional or facility outpatient setting may have payment or coding reimbursement policy issues
* Collaborate and coordinate with other departments to support ongoing program initiatives and quality improvement efforts
* Perform extensive research for coding guidelines, clinical protocols, benefit coverage, standard coding conventions and provider reimbursement rates
* Perform additional duties and projects as assigned by management

* Bachelor's degree in health care or related field
* Minimum 5 years of progressive/senior level of medical/hospital outpatient claims adjudication, clinical coding reviews/audits, utilization review/other relevant care management activity +/or working with  providers for medical/outpatient hospital coding + billing
* Working experience with Medicare claims processing policies, payment methodologies and NCCI guidelines
* High level of accuracy with special attention to details with efficient production outcomes
* Advanced skill level of Microsoft Excel + Word
* Proficient with medical terminology, medical coding and billing

Please visit our website @ 1199seiubenefits.org to learn about our health and pension benefits.


Elizabeth Zappa, Director of Clinical Compliance Programs

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