• Verify insurance benefits and coverage accurately and timely • Coordinate payments and assist with the processing of medical billing claims • Maintain accurate records of benefits, payments, and patient accounts • Communicate with insurance providers, clients, and internal teams to resolve billing issues • Ensure compliance with healthcare regulations and company policies • Support billing and benefits process improvements and reporting • Prepare documentation for audits and assist with payment reconciliations

• Perform posting charges • Perform completion of claims to payers • Conduct duties in a professional and timely fashion • Submit billing data to the appropriate insurance providers • Process claims • Resolve denial instances • Achieve maximum reimbursement for services provided • Deploy, maintain and report on various programs • Obtaining Pre-Authorizations from various insurance companies as needed. • Obtaining Verification of Benefits from various insurance companies.

Role Description Responsible for ensuring all charges from the Diagnostic Radiology have been appropriately prepared for posting on the patient's account. Working closely with the Business Services manager, this individual is accountable for the reconciliation of charge code exceptions on a daily basis. In addition, this position is responsible for monitoring and tracking all charges that have been released in the EMR (EPIC) for Billing and Coding. Investigates, reconciles, and follows up on all accounts being held in Work queues as Billing errors. Any variances are identified and reconciled in collaboration with Patient Financial Services, Revenue and Reimbursement, and the Hospital Billing Office. Individual works directly with Revenue and Reimbursement for updating, initiating, and auditing Revenue codes to ensure the appropriate CPT code has been assigned. The Revenue and Coding analyst works with Imaging managers and supervisors in reconciling and tracking Billing and Coding Edits and Denials for Imaging procedures ensuring optimal reimbursement. Works collaboratively with the Professional Billing leadership and coding team(s) to ensure the codes match for the Imaging procedure performed and the professional interpretation of the procedure. Understands and follows up on all Imaging procedures that have been assigned Modifiers that may impact reimbursement. Reviews and handles interventional procedures performed within Diagnostic Radiology, e.g., Breast Imaging procedures, Spine Injections, aspirations, etc., to ensure all codes have been appropriately assigned for optimum reimbursement under the direction of the Lead. Responsibilities - Reconciles and monitors all charge adjustments. - Reviews Error templates from Imaging Managers - Identifies late charges as identified in EPIC. - Identifies charges posting late to patient accounts - Ensures Imaging Exam codes in EPIC have appropriate CPT and EAP Codes. - Reviews requests for Imaging Exam Codes with section Manager - Reviews exam charge edits or denials as identified by billing, coding, and/or revenue reimbursement. - Provides feedback and expertise to questions related to charge edits, denials, or audits as identified - Reviews and documents Imaging charges released from EPIC Daily. - Prepares and runs Revenue and Usage reports from EPIC - Ensures all Work queues have been processed. - Reviews daily all Billing, Coding, Charge capture work queues - Performs quarterly audits as identified by the Lead. - Works with Lead and Business Mgr to run quarterly audits Qualifications - Must be a Certified Professional Coder with an Associate degree in Secretarial Science, Business or Healthcare related field required or equal number of years experience in a Healthcare / Third party payer environment. - Minimum 3 to 5 years experience in Medical Coding with an understanding of Third Party payor requirements, Medicare Medical Necessity, LCDs and ABNs. - Excellent telephone communications, interpersonal, coordination and organizational skills. - Ability to read computer screens, forms, and other documents and follow written and oral instructions. - Moderate keyboarding skills. - Ability to work in a fast-paced, changing environment. - Ability to respond to unpredictable, changing situations and needs with professionalism, good judgment, and excellent customer relation skills. - Prior customer service coordination or clinical experience necessary. - Excellent communication and people skills. - Individual must be articulate and confident in both oral and written communications. - Ability to remain calm and professional in high stress situations. Physical Demand - Primarily sedentary work sitting within typical office setting without exposure to adverse environmental conditions. - Requires occasional ability to lift, push and pull objects such as files and office supplies up to 30 pounds and/or continuously up to 10 pounds. - Occasional moving about on foot to accomplish tasks, walking long distances or moving from one work site to another. - Continuous use of telephones requiring ability to hear and speak to convey detailed or important instructions accurately, loudly or quickly. - Continuous use of computer and other office equipment requiring fingering and excellent keyboarding skills. YNHHS Requisition ID 176027

• Read and analyze patient records • Accurately and efficiently code for a variety of services including but not limited to, evaluation and management, laboratory, imaging, injections and infusions, and specialty surgical procedures in the clinic and hospital outpatient settings • Monitor, research, and correct claim denials within health plan requirements and document any trends with which to follow-up • Submits clean claims for payment • Complies with Federal and State standards utilizing CCI edits, Medicare bulletins, ACR bulletins, etc. to keep abreast of the changes within the industry • Maintains knowledge of and complies with coding guidelines • Find documentation in multiple EMR systems such as EPIC, ECW, Cerner, Meditech • Interacts with clients to ensure accuracy • Maintain patient confidentiality and information security • Maintain an error rate of 5% or less • Must meet production goals assigned by supervisor