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Medical Coding Specialist - Regulatory Affairs Job in Tarrytown, New York

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Job Title: Medical Coding Specialist - Regulatory Affairs

Employer:ENT And Allergy Associates LLP
Required Certifications:CPC,CEMC or CENTC,CCS,CCS-P,CPMA
Required Experience:1 to 2 years
Location:660 White Plains Road, Suite 500 Tarrytown 10591, NY, US
Date Posted:7/19/2019
Under the direct supervision of the Director of Regulatory Affairs, the Regulatory Affairs Associate will assist in the evaluation of ENT and Allergy Associates’ (“ENTA”) medical records and claims submissions to ensure completeness, accuracy, and compliance with applicable federal and state regulations and guidelines. This individual will also provide guidance and training on medical coding to physicians and staff.

The Regulatory Affairs Associate must have knowledge of third party billing procedures across a variety of payer systems and have specific expertise in CPT, ICD-9/ ICD-10 and HCPCS coding for a physician group- experience in ENT and/or Allergy specialties, a plus. Must also have a working knowledge of Evaluation and Management (E&M) coding and can conduct chart reviews using the 1995 and 1997 E&M Guidelines.? 

Responsibilities & Key Tasks

  • Assist in the oversight of compliance program and activities.
  • Assist with establishing compliance policies in accordance with the Company’s compliance strategies and priorities, and applicable laws, regulations, and industry codes.
  • Assist in the monitoring, and as necessary, coordination of compliance activities, to remain abreast of the status of all compliance activities and to identify trends.
  • Audits medical record documentation to identify coding deficiencies of services billed; prepares reports of findings and meets with providers to provide education and training on accurate coding practices and compliance issues.
  • Provides second-level review of billing performances to ensure compliance with legal and procedural policies and to ensure optimal reimbursements while adhering to regulations prohibiting unbundling and other questionable practices.
  • Researches, analyzes, and responds to inquiries regarding compliance, inappropriate coding, denials, and billable services.
  • Assist in the review, development, modification, and/or adaption of relevant ENTA procedures, protocols, and data management systems to ensure that physician billing operations meets state and local regulations.
  • Review monthly identified refunds as the result of Medical Management Committee activities to verify that a refund has been appropriately processed
  • Perform analysis of documentation as requested by external inquiries and assist in medical record collection/submission, and appealing findings.

  • Assist in the preparation of educational material training/education sessions
  • Associate’s degree in related field, with Bachelor’s preferred; may be supplemented with two (2) years of related work experience.
  • Coding certification (CPC, CCS, CCS-P, CPMA, CEMC or CENTC) required.
  • Compliance certifications (CHC, CPCO) preferred.
  • Two (2) years coding experience required.
  • Specific knowledge of the regulations and guidelines as they relate to documentation and coding.
  • Superior verbal, written, organizational and interpersonal skills required.
  • Competency with Microsoft Office (Excel, Word and PowerPoint) required.
  • Solid ability to organize and prioritize workload to manage multiple tasks and meet deadlines.

Occasional travel to ENTA’s clinical office locations will be required.

Performs miscellaneous job-related duties as assigned.

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