Revenue and Coding Specialist

Revenue and Coding Specialist

Cayuga Health and its affiliates are the region's leading healthcare system and most trusted providers of integrated health services, empowering our people in our mission to equitably improve the well-being of the communities we serve. Our commitment to providing extraordinary healthcare begins with our team of extraordinary professionals who are continuously discovering clinical innovations and enhancing access to the most up-to-date facilities, equipment, technologies, and research protocols. Cayuga Health's commitment to our employees includes competitive compensation, comprehensive employee benefits programs, and the opportunity to explore and build a career in healthcare through our many professional development programs. 

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.

Roles and Responsibilities:

• 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.

Required Skills and Experience:

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

Preferred Skills and Experience:

• Certified Coding Specialist Certification optional.
• 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.

Location and Travel Requirements:

• Hybrid / Onsite at CMC Biggs Building
• Schedule - 8-4:30

Pay Disclosure:

• $52,000 to $72,800 annually

Cayuga Health System and its affiliates are committed to treating all patients, providers, staff and volunteers equitably and with dignity, ensuring the highest levels of safety, care and respect, and striving to recognize and overcome biases and policies that contribute to disparities in healthcare access, equitable care and positive health outcomes for all.

We are proud to be an Equal Employment Opportunity employer, supporting the growth and health of our employees and community by embracing the rich diversity, needs and circumstances of all peoples and prioritizing opportunities to build a diverse and inclusive workplace. We do not discriminate based upon race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable protected characteristics.

If you require reasonable accommodation to complete a job application, pre-employment testing, a job interview or to otherwise participate in the hiring process, please contact the Cayuga Health Talent Acquisition team at talentacquisition@cayugahealth.org.

Current Openings for Revenue and Coding Specialist Jobs at Cayuga Health System