Loretto Management Corporation

Compliance & Reimbursement Specialist

Department
PACE - 1
Type
Regular Full-Time
Shift
First
Weekends Required?
No

Overview

PACE CNY is now hiring for a Compliance and Reimbursement Specialist. Come join a winning team!

 

The Compliance Reimbursement Specialist is responsible for analyzing documented clinical data, looking for areas where additional provider documentation is needed to better reflect the patient’s clinical picture while ensuring compliance with various state and federal regulations. In addition, the Specialist identifies, collects, assesses, monitors and reviews documentation and encounter coding as it pertains to managed care reimbursement.

 

Responsibilities

 

 

Top Responsibilities Include:

  • Conducting initial reviews of various medical record documentation to ensure the capture of all appropriate diagnoses/procedures related to reimbursement and compliance standards.
  • Routinely reviewing medical record information and coding to identify appropriateness based on CMS HCC categories.
  • Verifying and ensuring the accuracy, completeness, specificity and appropriateness of diagnosis codes based on documentation and services rendered.
  • Working daily with PACE CNY providers regarding provider documentation using a variety of training modalities to ensure capture of all applicable diagnoses/procedures related to reimbursement and compliance standards.
  • Serving as a resource to all PACE CNY staff regarding diagnostic and procedural coding, reimbursement processes, and other related questions.

Qualifications

  • Certified Coding Specialist (CCS/CCS-P), Certified Procedural Coder (CPC/CPC-H) certification, or Associates Degree with RHIT credentials required.
  • Minimum 2–3 years of outpatient coding experience necessary. A combination of outpatient and inpatient (hospital setting) preferred.
  • Proficient with ICD-10 coding. Understanding of DRG systems and other reimbursement methodologies a plus.
  • Proficient with MS Office and able to learn new software rapidly. Prior experience with Electronic Medical Records highly desirable.
  • Strong organizational and analytical skills with ability to prioritize work necessary.
  • Knowledge and experience in managed care environment highly desirable.

 

 

 

 

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