Description

The Sr. Coding Analyst (SCA) will develop and support implementation of medical billing and coding best practices across a quickly growing, primary care practice network. The SCA is primarily responsible to assist with identifying gaps in submissions, ensuring correct clinical documentation and identifying areas of coding improvements for CMS Medical Billing, Risk Adjustment and Quality Incentive programs. He/she will also educate market operators, analysts, primary care physicians and advanced practice providers on processes for improving coding performance.

What are some examples of initiatives you will be driving as a Sr. Coding Analyst at VillageMD? 

• CPT billing and claims processing guidelines - compliance with established protocols and procedures
  • Formalize existing billing documents and SOPs related to documentation, CPT billing and claims processing
  • Complete chart audits to inform protocol and procedure development
• Billing workflow support and development
  • Work with market operators to suggest best practices for operationalizing billing workflows and claims processing (e.g. Gcodes, ancillary codes, TCM, CCM)
  • Assist with research, analysis, and response to inquiries regarding compliance, billing, and inappropriate billing (e.g. EM)
  • Develop plans and materials that support the educational and training needs of the medical practice, by collaborating with internal departments
• HCC support and education
  • Review medical records and decipher if they are accurate and complete and in support of patient risk adjustment score accuracy
  • Validate missed coding opportunities
  • Recognize coding opportunities and support development of coding workflows
  • Conduct individual training and group education sessions on proper coding and documentation practices for physicians and staff consistent with industry standards and in compliance with coding guidelines 

What will make you successful here?

• Willingness and ability to travel 25% to our markets (averaging 1-2 days weekly over the calendar year)
• Self-motivated: energetic, self-starter; can work autonomously with limited direction
• Results oriented: bias for action; demonstrated track record of achievement; drive for attainment of superior outcomes
• Flexible: ably navigates within ambiguity; solution-oriented
• Analytical: strong research, writing, analytical and critical reasoning skills
• Communication: conveys thoughts and expresses ideas effectively both verbally and in writing
• Collaboration: orientation to team-based work product and results
• Humility: low ego; engenders trust; respectful 

The following experience is relevant to us:

• Bachelor’s degree in Health Information Management, Nursing or comparable field highly preferred
• Professional Coding Certification such as CCS, CPC or CRC, required
• A minimum of 3 years of experience in advanced professional coding
• Highly proficient with payer policies and guidelines
• Familiarity with Electronic Health Records documentation and professional fee billing methodologies
• Experience providing coding education in an ambulatory environment (Primary Care Practice highly preferred)
• Proven success in building relationships and establishing credibility with doctors, nurses and other clinical staff