Medical Coder

Planned Parenthood of Greater New York • Queens, NY

9d

About The Position

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

The position develops audit and education programs, identifies documentation and coding compliance opportunities, and works with providers, clinical leadership, health center operations, an EPIC hosting organization, and a third-party revenue cycle management vendor. It also monitors process changes and their financial impact, reviews code changes for accuracy and compliance, and maintains current knowledge of 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. It requires prolonged sitting and computer use, periodic standing, walking, and bending, and the ability to lift or move up to 15 pounds. A flexible schedule may be required, including work exceeding 7.5 hours per day or 37.5 hours per week during peak activity periods.

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 to build effective professional relationships with internal and external stakeholders.
• Ability to work effectively as part of a team and collaboratively across organizational workgroups.
• Proficiency with Microsoft Office Suite, including advanced Excel skills such as Pivot Tables and V Look Ups.
• Deep understanding of EMR systems and experience in an EPIC environment.
• Strong data management and data analysis skills, research orientation, and ability to critically analyze large data sets.
• In-depth knowledge of Medicare and New York State Medicaid regulations, including billing, coding, and documentation requirements.
• Excellent 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, make independent decisions, and work reliably with minimal direct supervision.
• Ability to handle confidential information with discretion and maintain a strong work ethic.
• Ability to lift or move up to 15 pounds; perform prolonged sitting and repetitive computer tasks; and periodically stand, walk, bend, reach, grasp, push, and pull.
• Visual acuity sufficient for frequent computer-screen work and review of printed materials, and ability to hear and communicate orally.
• Proof of immunization or immunity to certain communicable diseases, including influenza during flu season and COVID-19, and tuberculosis testing.

Nice To Haves

• Coding certification such as CCS, RHIA, or RHIT, or applicable experience.
• Experience working with a variety of commercial contracts.
• Experience with principles of process improvement.
• Commitment to learning about and enhancing practices related to racial equity and its impact on healthcare systems.
• Ability to mentor a culturally diverse team and foster an inclusive and equitable organizational culture.

Responsibilities

• Audit provider charges and coding to determine appropriate ICD-10 and CPT codes for reporting provider services to third-party payers.
• Review modifier use for billing compliance and appropriate reimbursement.
• Identify clinical documentation integrity and coding compliance opportunities.
• Develop documentation strategies and messages collaboratively with relevant stakeholders.
• Provide education, training, mentoring, and feedback to providers and other stakeholders.
• Develop an audit program for new providers and providers identified through external coding audits or periodic reviews of problematic areas.
• Maintain an ongoing provider-specific audit and education platform to identify training opportunities.
• Recommend and coordinate automated solutions with the EPIC hosting organization.
• Collaborate with the third-party RCM vendor and health center operations to implement process changes.
• Work with cross-functional teams to align clinical operations with PPGNY billing practices.
• Track adherence to implemented process changes and quantify their financial impact.
• Review CPT, HCPCS, and revenue code changes 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 train providers and provide performance feedback.
• Maintain current knowledge of compliant clinical documentation, coding, billing, CMS billing rules, and payer requirements; proactively identify policy changes.
• Perform other training and mentoring duties as required.

Benefits

• Generous paid time off and holiday schedule.
• Medical, dental, and vision coverage options for employees and eligible dependents.
• FSA, HSA, 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