Accounts Receivable, Certified Professional Coder

Columbia University
United States, New York, New York
Dec 21, 2024
Job Type: Officer of Administration Regular/Temporary: Regular Hours Per Week: 35 Standard Work Schedule: 9AM-5PM, M-F Salary Range: $65,000.00-$75,000.00 The salary of the finalist selected for this role will be set based on a variety of factors, including but not limited to departmental budgets, qualifications, experience, education, licenses, specialty, and training. The above hiring range represents the University's good faith and reasonable estimate of the range of possible compensation at the time of posting. Position Summary The Certified Professional Coder (CPC) is responsible for accurate coding of medical records and claims within the Clinical Revenue Office's Accounts Receivable department. This role ensures compliance with payer regulations, supports denial resolution, and contributes to efficient revenue cycle operations. The CPC plays a vital role in ensuring proper billing and reimbursement while maintaining high standards of compliance and accuracy. Responsibilities Accounts Receivable Coding Research root causes of claim denials and apply knowledge of payer policies to determine the appropriate course of action, including appeals. Manages complex coding-related cases and recommends resolutions while escalating issues when necessary. Prepares and reviews correspondence with insurance companies, patients, or guarantors to address claim-related inquiries. Documents all actions and findings in the billing system to maintain accurate and comprehensive account records. Collaborates with the senior leadership to address unresolved or escalated issues. Coding and Charge Review Reviews charges in work queues for compliance and accuracy, ensuring alignment with Current Procedural Terminology (CPT), ICD-10, and other coding standards. Performs reconciliation of charges against appointment reports or procedure logs to ensure all patient services are billed appropriately. Verifies the accuracy of charge header information, including service provider, billing area, CPT codes, modifiers, and diagnosis linkage. Communicates with providers to resolve discrepancies via Epic or a secure chat. Reviews charge correction requests and ensures accuracy prior to resubmission. Denials Management Collaborates with Accounts Receivable staff to resolve denied or rejected claims related to coding issues. Provides expertise in payer-specific coding requirements to facilitate successful appeals and payment recovery. Tracks trends in denials and recommends process improvements to reduce future errors. Insurance Verification and Compliance Conducts thorough insurance verification to ensure accurate claim submission and timely reimbursement Updates patient accounts with corrected demographic or insurance information as necessary. Ensures compliance with organizational and regulatory coding standards, including HIPAA and Medicare/Medicaid guidelines. Continuous Improvement Monitors key performance indicators and participates in performance improvement initiatives. Provides coding expertise to support department goals and enhance revenue cycle operations. Compliance & Other Performs other tasks and assumes additional responsibilities within the Revenue Cycle Department as assigned. Represents the FPO Clinical Revenue Office on cross-functional committees, task forces, and work groups as assigned. Conforms to all applicable HIPAA, Billing Compliance, and safety policies and guidelines. Please note: While this position is primarily remote, candidates must be in a Columbia University-approved telework state. There may be occasional requirements to visit the office for meetings or other business needs. Travel and accommodation costs associated with these visits will be the responsibility of the employee and will not be reimbursed by the company. Minimum Qualifications Bachelor's Degree or an equivalent combination of education and experience. A minimum of 3 years of medical coding experience, preferably in a physician billing or third-party payer environment. An equivalent combination of education and experience may be considered. CPC certification is required. Proficiency in CPT, ICD-10, and HCPCS coding, as well as payer-specific billing guidelines. Strong working knowledge of managed care eligibility, referrals, and authorizations. Demonstrated ability to interpret clinical documentation and ensure compliance with coding and billing standards. Excellent organizational skills and attention to detail with the ability to handle multiple tasks effectively. Proficiency in Microsoft Office (Word, Excel) and electronic health record systems (e.g., Epic). Must successfully complete systems training requirements. Preferred Qualifications Experience in a physician practice or healthcare setting. Experience in EPIC. Familiarity with quantitative and qualitative data analysis related to coding and billing. Competencies Patient Facing Competencies Minimum Proficiency Level Accountability & Self-Management Level 3 - Intermediate Adaptability to Change & Learning Agility Level 2 - Basic Communication Level 2 - Basic Customer Service & Patient Centered Level 3 - Intermediate Emotional Intelligence Level 3 - Intermediate Problem Solving & Decision Making Level 3 - Intermediate Productivity & Time Management Level 3 - Intermediate Teamwork & Collaboration Level 2 - Basic Quality, Patient & Workplace Safety Level 3 - Intermediate Leadership Competencies Minimum Proficiency Level Business Acumen & Vision Driver Level 1 - Introductory Performance Management Innovation & Organizational Development Level 1 - Introductory Equal Opportunity Employer / Disability / Veteran Columbia University is committed to the hiring of qualified local residents.