Title: Medical Coding and Billing Assistant 1 Location: Off Campus within Connecticut Remote Part-time Job Description: Working at Yale means contributing to a better tomorrow. Whether you are a current resident of our New Haven-based community, eligible for opportunities through the New Haven Hiring Initiative, or a newcomer, interested in exploring all that Yale has to offer, your talents and contributions are welcome. Discover your opportunities at Yale! Overview Under the direction of Yale Medicine Administration (YMA) Coding and Billing, the Coding and Billing Assistant 1 is responsible for reviewing all aspects of charge submission for patient clinical services based on coding, documentation review, quality assurance, and compliance guidelines. Reviews charge submissions for compliance with established coding guidelines, all YMA policies and protocols, third party reimbursement policies, Federal payer regulations, and HIPAA guidelines. Performs effective workflow processes to file complete, accurate and timely billing of professional charges, while maintaining productivity to meet lag day expectations. May review and analyze documented medical services to verify accurate documentation and coding of services performed. Required Skills and Abilities 1. General/intermediate knowledge of ICD-10, CPT, HCPCs and modifier coding, medical terminology, human anatomy, and digital coding resources and software. Ability to analyze and interpret evaluation and management documentation guidelines as well as procedures and applicable coding guidelines. 2. Demonstrated ability with an electronic health record and practice application systems, electronic data entry, and web-based applications and websites. Intermediate proficiency with MS Word, Excel, Outlook (emails and calendars). 3. Demonstrated knowledge of Federal payer regulations, third party payers, HIPAA rules, reimbursement policies and procedures. Proven ability to interpret and apply guidelines. 4. Demonstrated strong interpersonal, verbal and written communication skills. Ability to effectively communicate with team members to resolve questions regarding collaboration and assignments. Communicate effectively with providers, following escalation processes with analytics team and manager. 5. Demonstrated ability to work independently; organize and prioritize own work with minimal supervision; ability to work in a fast-paced environment meeting timely deadlines while maintaining productivity and quality standards. Ability to work effectively as a team member with common goals. Preferred Education, Experience and Skills Previous Epic experience; experience within an academic medical environment or large multi-specialty practice; CPC certification preferred. Principal Responsibilities 1. Performs work queue resolution of medical billing charge sessions by reviewing clinical documentation to confirm diagnostic (ICD-10) and procedural (CPT/HCPCS) codes and modifiers, based on charge review edits for Yale Medicine patient clinical services filed to charge review work queues. May perform manual charge entry for non-Epic services. With an ability to navigate within the Professional Billing applications, ensures that all charge review edits are appropriately resolved in charge review work queues utilizing claim judgement and critical thinking skills. Draws valid conclusions to support decisions. 2. May verify all information required to submit a clean claim including provider, place of service, date of service, bill area, all codes and special billing procedures that may be defined by a payer, contract or YMA. Ensures compliance with Teaching Physician guidelines within an academic medical practice. 3. Pends charge sessions to seek corrective action for services not meeting documentation requirements in accordance with YMA policies and procedures. May identify that a provider should be contacted to clarify or amend a medical record, following communication and escalation procedures. May modify clinician’s selection. 4. Adheres to YMA policies and procedures and Yale Medicine’s Mission, Values and Guiding Principles. Actively participates in team and department training and education programs and staff meetings. Establishes and cultivates productive relationships among staff to support a positive team environment and professional interactions. Maintains professional and technical knowledge by participating in educational workshops and reviewing professional publications. 5. May perform other duties as assigned. Required Education and Experience Four years of related work experience, two of them in the same job family at the next lower level, and high school level education; or two years of related work experience and an Associate’s degree, or an equivalent combination of experience and education. Required License(s) or Certification(s) Certified Professional Coder Apprentice (CPC-A) through AAPC organization. Must maintain certification through annual education requirements and achieve CPC status within 2 years. Preferred Licenses or Certifications Certified Professional Coder (CPC) Physical Requirements Ability to push, pull, and lift in excess of 20 pounds as well as travel around the medical school campus. Job Category Administrative Support Bargaining Unit L34 Compensation Grade Labor Grade D Compensation Grade Profile Hourly Range $31.83 Time Type Part time Duration Type Temporary / Casual (Fixed Term) Work Model Remote Background Check Requirements All candidates for employment will be subject to pre-employment background screening for this position, which may include motor vehicle, DOT certification, drug testing and credit checks basedon the position description and job requirements. All offers are contingent upon the successful completion of the background check. For additional information on the background check requirements and process visit "Learn about background checks" under the Applicant Support Resources section of Careers on the It's Your Yale website. Health Requirements Certain positions have associated health requirements based on specific job responsibilities. These may include vaccinations, tests, or examinations, as required by law, regulation, or university policy. Posting Disclaimer The hiring rate of a role is determined in accordance with the provisions outlined in the respective collective bargaining agreement. The intent of this job description is to provide a representative summary of the essential functions that will be required of the position and should not be construed as a declaration of specific duties and responsibilities of the position. Employees will be assigned specific job-related duties throughtheir hiring department. The University is committed to basing judgments concerning the admission, education, and employment of individuals upon their qualifications and abilities and seeks to attract to its faculty, staff, and student body qualified persons from a broad range of backgrounds and perspectives. In accordance with this policy and as delineated by federal and Connecticut law, Yale does not discriminate in admissions, educational programs, or employment against any individual on account of that individual’s sex, sexual orientation, gender identity or expression, race, color, national or ethnic origin, religion, age, disability, status as a special disabled veteran, veteran of the Vietnam era or other covered veteran. Inquiries concerning Yale's Policy Against Discrimination and Harassment may be referred to the Office of Institutional Equity and Accessibility (OIEA). Note Yale University is a tobacco-free campus.

• Review and analyze clinical documentation to assign accurate diagnosis, procedure, and service codes for facility and professional billing • Code inpatient, outpatient, emergency department, observation, clinic, and ambulatory surgery encounters • Assign ICD-10-CM, ICD-10-PCS, CPT, HCPCS Level II, and applicable modifiers in accordance with official coding guidelines • Ensure coding accuracy, completeness, and compliance with CMS, Medicare, Medicaid, commercial payer, and regulatory requirements • Query providers when documentation lacks specificity necessary for accurate code assignment • Participate in coding quality reviews, audits, and education initiatives • Maintain productivity and quality standards established by the organization • Research coding regulations, payer policies, and reimbursement guidelines • Assist in denial management, appeals, charge capture reviews, and revenue cycle optimization efforts • Support onboarding and mentoring of junior coding staff when assigned • Assist in other duties as assigned.

• Determines Correct Codes For Diagnoses And Procedures For Office And Surgical Records • Assigns Cpt And ICD-10 Codes For Billing Reimbursement

Role Description This position is located in the Health Information Management (HIM) in Health Administration Service (HAS) at the Marion, IL VA Medical Center. The Lead Medical Records Technician (Coder) Outpatient and Inpatient is skilled in classifying medical data from patient health records in the hospital setting, and/or physician-based setting, such as physician offices, group practices, multi-specialty clinics, and specialty centers. The Lead MRT (Coder) monitors the status and progress of work and day-to-day adjustments in accordance with established priorities. The duties include but are not limited to: - Instructs employees in specific tasks and job techniques and makes available written instructions, reference materials, and supplies. - Gives on-the-job training to new coders and students to provide the individual with basic knowledge, skill, and ability to perform a full range of routine and non-routine responsibilities. - Trains and works closely with professional and administrative staff to assist in the development, maintenance, and use of ICD and CPT codes to ensure accurate data capture. - Conforms to standards and participates in the technical evaluation and validation of health records for compliance with The Joint Commission requirements, Center for Medicare & Medicaid Services (CMS), and/or health record documentation guidelines. - Distributes and balances the workload among employees in accordance with established workflows or job specialization, assuring timely accomplishment of the assigned workload. - Reviews compliance monitors with supervisors and identifies training needs. - Reviews audits, trains, monitors, and completes special assignments within specified time frames. - Analyzes and recommends improvements in documentation systems used to provide patient care to optimize VERA workload, third-party reimbursement, and to manage resources. - Identifies training needs of individuals based on productivity and accuracy reports, rejects filing from billing, and spot checks. - Makes recommendations to supervisor concerning disciplinary actions due to insufficient performance and identifies continuing education needs. - Required to train others on the encoder products suite. Utilizes this system on an ongoing basis to perform core coding duties and audits. - Takes the initiative in one-on-one provider training to improve health record documentation for the episodes of care provided. - Has constant interaction with health care providers, evaluating, and communicating with the expectation of improving health record documentation, which will result in improved patient care and improved revenue generation. - Educates providers through feedback, email queries, or informal meetings. - Participates in the orientation of House Staff from affiliated medical schools and other personnel needed. - Other duties as assigned. Qualifications - United States Citizenship: Non-citizens may only be appointed when it is not possible to recruit qualified citizens in accordance with VA Policy. - Experience: One year of creditable experience that indicates knowledge of medical terminology, anatomy, physiology, pathophysiology, medical coding, and the structure and format of health records. - Education: An associate's degree from an accredited college or university recognized by the U.S. Department of Education with a major field of study in health information technology/health information management, or a related degree with a minimum of 12 semester hours in health information technology/health information management. - Completion of an AHIMA approved coding program, or other intense coding training program of approximately one year or more that included courses in anatomy and physiology, medical terminology, basic ICD diagnostic/procedural, and basic CPT coding. - Experience/Education Combination: Equivalent combinations of creditable experience and education are qualifying for meeting the basic requirements. Requirements - Certification: Persons hired or reassigned to MRT (Coder) positions in the GS-0675 series in VHA must have either Apprentice/Associate Level Certification, Mastery Level Certification, or Clinical Documentation Improvement Certification through AHIMA or AAPC. - English Language Proficiency: Must be proficient in spoken and written English as required by 38 U.S.C. § 7403(f). - Mastery level certification is required for all positions above the journey level. Benefits - Work Schedule: Monday - Friday 8:00am - 4:30pm CST - Telework: Not Eligible - Virtual: This position is remote work eligible and is currently exempted from return to office requirements. - Relocation/Recruitment Incentives: Not Authorized - Permanent Change of Station (PCS): Not Authorized Physical Requirements Physical aspects associated with work required of this assignment are typical for the occupation and would generally not require a pre-placement examination.