Full Time Billing and Coding Compliance Analyst – Hunterdon Healthcare, Flemington NJ

Position Summary:

Responsible for the application and maintenance of medical necessity software, ensuring compliance related to Medicare billing requirements, conducting internal audits relating to medical necessity, analyzing medical necessity denials, implementing and maintaining the Advanced Beneficiary Notice (ABN) process, and communicates changes as identified to the CDM Coordinator to aide in maintaining the chargemaster – HCPCS and revenue code updates, additions and deletions as it relates to medical necessity.

Primary Position Responsibilities:

Trains Hospital Department Staff (Registrars) on Advanced Beneficiary Notice requirements. Prepares policies and procedures related to the ABN process. Notifies Hospital Departments of all Local and National Medical Necessity Policies. Reviews Medical Necessity Determinations and advises appropriate Departments of new, retired or changed Policies.

Reviews medical necessity issues with Physician Offices as needed. Ensures that ABNs issued by software are appropriate. Explains ABNs to patients and/or their family when necessary as well advising Physician Office when ABN will be delivered.

Reviews ADR's /Medical Records prior to being sent to Intermediary for signature and documentation requirements. Audits denials, updates ADR spreadsheet, and files appeals if appropriate for denial resulting from an ADR request.

Verifies units for MUE's and Excess Units by reviewing documentation and consulting with hospital departments. Adds appropriate modifiers for MUE's and excess units per coding guidelines. Reviews Commercial and Medicare HMO edits/denials and adds appropriate modifier per coding guidelines. Reviews combined accounts for coding. Reviews RTP Medicare claims for modifier or coding edits. Adds coding for NextGen SPCM claims – Commercial per Owned offices request.

Reviews Gaffey Medicare Compliance Reports.

Files Appeals for Medicare Medical Necessity Issues as appropriate (ED, OBSV, SDS and Radiology Claims).

Communicates CMS updates and revisions to the appropriate departments in collaboration with the Director of Patient Financial Services/CDM Coordinator and or designee.


Minimum Education Required:

High School Diploma or Equivalent

Minimum Years of Experience Required:

Minimum five years medical billing experience

Preferred:  Chargemaster experience preferred

License, Registry or Certification:

Required:  Medical coding certification

Preferred:  Billing Compliance, CPC, CDM knowledge, CPAT, CPAM preferred

Knowledge, Skills and/or Abilities:

Required:  Demonstrates strong analytical skills.

Demonstrates strong written and verbal communication skills (Word/Excel)

Demonstrates ability to interact successfully with persons at all levels of the organization.

Demonstrates ability to work independently in a productive, goal-oriented manner

Preferred:   Knowledge of QuadraMed - Affinity software's coding compliance module and charge master for insurance billing.

PLEASE APPLY ON-LINE at www.hunterdonhealthcare.org

(3/26/18 - 6/26/18)