DUTIES: The position will take part in the Documentation, Coding/Billing Auditing and Monitoring Program for the Clinical Enterprise, including but not limited to the following: - Design and implement our documented annual program, with quarterly goals, that meet governmental, internal Compliance Program requirements and operational policies and procedures relative to all clinical reimbursement areas with specific attention to Registration, Admitting, Health Information Management, Accounts Receivable, Managed Care, Utilization Review/Case Management, and Discharge Planning. This includes: Revenue Cycle vulnerability assessments; Researching Federal and State regulations; Selection of audit sampling; Review of medical record documentation and ICD-10 and CPT coding/billing; Validation of DRG grouping for Inpatient cases; Validation of APC grouping for Outpatient cases; Individual and group physician education and training; Individual and group coder education and training; Support staff education and training; Charge Master Description Review; Relevant policy and procedure review and revision; and IPRO liaison for Payment Error Prevention. - Inform and educate Departmental Administrators of OCAS' objectives and work plan relevant to their department prior to the start of a scheduled review or audit. - Hold regular meetings with Departmental Administrators to review objectives and provide status reports. - Provide formal reports of results with recommendations for improvement, where required, to the Department Administrators. (When appropriate, immediate notification of a problem to the Administrator is required.) - Perform formal education and training, as required. - Develop and present formal quarterly reports of annual program status for submission to the VP of Compliance and Audit. - Provide formal year-end reporting and presentations. - Provide updates, to the staff, regarding Center for Medicare and Medicaid Service (CMS) regulatory compliance (DUTIES AND RESPONSIBILITIES ARE NOT LIMITED TO THE ABOVE POSITION DESCRIPTION) QUALIFICATIONS: - Registered Health Information Administrator (RHIA) and/or Certified Coding Specialist: CCS, CCS-P. - At least five (5) years of advanced medical record analysis, experience with documentation requirements, ICD-10 and HCPCS coding, and third party reimbursement. - Thorough knowledge of clinical reimbursement regulations with an emphasis on Physician at Teaching Hospital (PATH) guidelines. - A strong knowledge base of both Medicare Part A and Part B and Medicaid requirements with specific expertise in Diagnostic Related Groups (DRG's), Ambulatory Payment Classifications (APC's) and Ambulatory Patient Groups (APG's). - Proficiency in ICD-10 Coding principles. - Proficiency in Current Procedure Terminology (CPT) coding with an emphasis on Evaluation and Management (E&M) Services. - Intimate knowledge of Coding Clinic guidelines. Experience with both regulatory issues and third party reimbursement. - Full understanding of the Medicare Outpatient and Inpatient Prospective Payment Systems. - Experience with clinical reimbursement analysis. - Benchmarking experience. - Project and operational management experience in a teaching hospital setting. Additional Info: *Please ensure you include the 5-digit Line Number and Job Title in the subject line and body of your email submission.Closing Date: Open Until Filled STATE UNIVERSITY OF NEW YORK IS AN EQUAL OPPORTUNITY / AFFIRMATIVE ACTION EMPLOYER
Internal Number: 53248
About SUNY Downstate Medical Center
SUNY Downstate's College of Medicine, Health Related Professions, Nursing and its School of Graduate Studies offer students a broad professional education that will prepare them for practice or careers in any location and community. This education provides exceptional opportunities for those students with a commitment to promoting health in urban communities and addressing the complex challenges of investigating and preventing diseases that confront clinicians, educators, and researchers in such an environment. This special aspect of Downstate's unique mission is reflected in the students it attracts and selects, the vast majority of whom are drawn from the New York City Metropolitan area. Many of these students are members of minority and cultural groups underrepresented in the health professions, and/or come from families of first-generation immigrants or from economically disadvantaged backgrounds.