Revenue & Coding Specialist

Company Overview:

Cayuga Health is the region's leading healthcare system, and most trusted driver of integrated health services, together with valued partners. We empower our people and employ our capabilities to equitably improve the well-being of the communities we serve. At Cayuga Health System, our commitment to providing extraordinary health care begins with our team. Our extraordinary professionals are continuously discovering clinical innovations and enhanced access to the most up-to-date facilities, equipment, technologies, and research protocols. We have a commitment to its employees by providing competitive rates and compensation, a comprehensive employee benefits programs, attractive working conditions, and the chance to build and explore a career opportunity by offering professional development.

Nestled in the beautiful Finger Lakes region, Cayuga Health provides an outstanding place to work in a vibrant community. Come discover all that Ithaca, New York and Cayuga Health has to offer!

Position Overview:

The Revenue Coding Specialist assists with compliance, education, accuracy in charge capture, and improvement in the revenue cycle processes for our Cayuga Health Partners Practices. This includes analysis of patient clinical and billing data to identify documentation, coding, and charging opportunities. This position will work collaboratively with all practices in the CHP Network and serves as a liaison between practices, hospitals, and payers as indicated. This position serves as an information resource and guide, champion to promote best coding behaviors, and serve as subject matter expert for reimbursement and billing questions. The Revenue Coding Specialist is responsible for maintaining a working knowledge of coding and billing regulations for all payers. Keeps current on regulatory updates, contractual agreements, local payer policies and procedures to ensure charge accuracy, compliance and optimization for CHP Practices. This includes calculating anticipated reimbursement rates for various payers and reconciling with payments.

What you'll do:

• Evaluating new procedures to insure revenue optimization for CHP Practices to determine coverage and potential reimbursement for various payers.
• Calculating anticipated reimbursement rates issuing RVUs for various payers and reconciling with payments.
• Assists CHP Practices with denial investigations and root cause analysis. Including identifying opportunities for denial prevention and any necessary follow-up with payers to resolve any denial errors.
• Maintains working knowledge of coding and billing regulations for all payers. Keeps current on regulatory updates, including NYS insurance laws and regulations, local payer policies and procedures to ensure charge accuracy, compliance and optimization for CHP Practices.
• Understands claim edits to assist CHP Practices with compliance of Local Coverage Determinations (LCD), National Coverage Determination (NCD), as well as payer specific edits as outlined via contractual agreements particularly around coding matters and when other factors causing the edits are identified assists CHP Practice to ensure a clean claim is submitted.
• Maintain knowledge of Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS), ICD-10- CM/PCS, Ambulatory Payment Classification (APC), and Outpatient Prospective Payment System (OPPS) reimbursement structures and Outpatient Coding Edits (OCE)/Correct Coding Initiative (CCI) edits.
• Is flexible in assuming other appropriate responsibilities not noted above.

Minimum Qualifications:

Education - Associates' degree in a healthcare related field, Finance, Business, or Accounting or equivalent work experience. Certified Coding Specialist Certification optional. Completion of college credited course work in Medical Terminology, Anatomy & Physiology and Pathophysiology/Disease Processes/Pharmacology required.

Experience - Must possess a demonstrated advanced knowledge of clinical processes, clinical coding (CPT, HCPCS, ICD-10-CM/PCS, revenue codes and modifiers), NYS insurance regulations, RVUs, billing processes and audits, including knowledge of charge capture, reconciliation, error management operations and overall revenue cycle operations required

Licensure - AAPC CPC (no CPC-A), and/or AHIMA CCS preferred.

Physical Requirements: Must be able to remain in a stationary position at least 50% of the time. The person in this position frequently communicates with Practices. Must be able to exchange accurate information in these situations. This position may require occasional driving to practice locations.

At this time Cayuga Health System will not sponsor a new applicant for employment authorization for this position.

If you are interested in applying for this position and you require an accommodation, please contact Cayuga Health System at hr@cayugamed.org

Cayuga Health System Commitment to Diversity, Equity & Inclusion

Cayuga Health System commits to treating all people with dignity so that everyone who comes to us is safe, cared for, and respected. We will support the growth of our employees and the health of our community by embracing the rich diversity of social and cultural identities, needs, and life circumstances of all people. We strive to recognize and overcome personal biases and systemic policies that marginalize others and contribute to disparities in healthcare access, equitable care, and good health outcomes.

Cayuga Health is dedicated to our vision for diversity, equity, and inclusion. As we strive towards our vision, we welcome the opportunity to work alongside a diverse range of employees.