Coder

Planned Parenthood of Greater New York • New York, NY

3d • Onsite

About The Position

The Coder supports the VP of Revenue Cycle and Revenue Optimization by auditing provider clinical documentation and evaluation and management (E/M) coding. The role develops and presents coding and clinical documentation education and training for providers, and performs charge audits by reviewing chart notes and identifying appropriate procedure and diagnosis codes.

The position develops audit programs and ongoing provider-specific auditing and education processes, reviews coding and documentation for compliance and reimbursement accuracy, and collaborates with clinical operations, the EPIC hosting organization, third-party revenue cycle management vendors, and other stakeholders to implement process changes and automated solutions. It tracks adherence to implemented changes and measures their financial impact. The Coder also evaluates external coding audit results, provides provider feedback and training, and maintains current knowledge of clinical documentation, coding, billing, CMS rules, and payer requirements.

This role operates in a professional office environment, with potential exposure to communicable diseases and other conditions in a health center environment. The position requires a flexible schedule and may involve working more than 7.5 hours per day or 37.5 hours per week during peak activity periods. PPGNY requires proof of immunization or immunity to certain communicable diseases and tuberculosis testing.

Requirements

• At least eight years of experience in physician/provider coding, auditing, and education.
• At least two years of experience with EPIC EMR.
• Excellent customer service, communication, interpersonal, written, and verbal skills.
• Ability to remain focused and calm in stressful situations and maintain effective professional relationships with internal and external stakeholders.
• Ability to work effectively as part of a team and collaboratively across organizations.
• Proficiency with Microsoft Office Suite, including advanced Excel skills such as Pivot Tables and VLOOKUPs.
• Deep understanding of EMR systems and experience in an EPIC environment.
• Strong data management and data analysis skills, with the ability to research and critically analyze large data sets.
• In-depth knowledge of Medicare and New York State Medicaid regulations, including billing, coding, and documentation requirements.
• Experience working with a variety of commercial contracts and with process improvement principles.
• Strong organizational and time management skills, including the ability to meet deadlines and produce high-quality work in a fast-paced environment.
• Ability to exercise sound judgment and independent decision-making, produce reliable work with minimal direct supervision, and handle confidential information discreetly.
• Demonstrated commitment to PPGNY’s mission, bodily autonomy, health equity, gender and racial justice, and learning about racial equity and its effects on healthcare systems.
• Ability to build trust and work effectively across cultural differences, mentor a culturally diverse team, foster inclusion and equity, and provide developmental feedback and accountability.
• Ability to coordinate work with internal and external partners and engage in mutual problem solving.
• Strong work ethic.
• Proof of immunization or immunity to certain communicable diseases, including influenza during flu season and COVID-19, and tuberculosis testing, as required by applicable health and safety rules.
• Ability to meet the physical demands of prolonged sitting, repetitive computer work, periodic standing, walking and bending, lifting or moving up to 15 pounds, and reaching, grasping, pushing, and pulling; sufficient visual acuity and ability to hear and communicate orally.

Nice To Haves

• Coding certification such as CCS, RHIA, or RHIT, or applicable experience.

Responsibilities

• Perform charge audits and coding reviews to determine appropriate ICD-10 and CPT codes for reporting provider services to third-party payers.
• Review and identify accurate use of modifiers to support billing compliance and optimal reimbursement.
• Identify clinical documentation integrity opportunities and drive documentation strategies in collaboration with relevant stakeholders.
• Provide education and training to providers and other appropriate stakeholders, including mentoring as required.
• Develop audit programs for new providers and providers identified through external coding audits or periodic reviews of problem areas.
• Develop ongoing auditing and education processes to identify provider-specific training opportunities.
• Recommend and work with the EPIC hosting organization to implement automated solutions.
• Collaborate with third-party revenue cycle management vendors and health center operations to implement process changes.
• Work with cross-functional teams to align clinical operations with PPGNY billing practices.
• Track adherence to process changes and quantify their financial impact.
• Review changes in CPT, HCPCS, and revenue codes for accuracy, compliance with billing guidelines, and reimbursement optimization.
• Evaluate periodic coding audit results from an outside agency and partner with revenue cycle and clinical services leadership to provide provider training and feedback.
• Maintain current knowledge of compliant clinical documentation, coding, billing, CMS billing rules, and payer requirements, and identify policy changes proactively.

Benefits

• Generous paid time off and holiday schedule.
• Medical, dental, and vision coverage options for employees and eligible dependents.
• Flexible spending account, health savings account, and commuter pre-tax reimbursement funds.
• Short- and long-term disability coverage.
• Free basic life and AD&D coverage.
• 401(k) retirement plan with Safe Harbor contributions after one year of employment.

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Education Level: No Education Listed