1. Acts as an expert resource on proper procedural and diagnostic coding and changes in codes and coding practices as they reflect changes in medical practices.  Based on a high level of medical knowledge of human anatomy and physiology in specialized medical fields and procedures, reviews and revises the coding of medical professionals, including physicians and APPs.  Advises medical professionals and D-level Coding Specialists in order to ensure accuracy of coding and reimbursement of claims and compliance with government regulations and third-party carrier requirements.  2. Reviews operative and diagnostic reports, as well as procedures and E&M service documentation to validate diagnostic (ICD-10) and procedural (CPT/HCPCS) codes and modifiers with consideration given to charge review edits within work queues for Yale Medicine patient clinical services.  Expert resource within the Epic Professional Billing application, ensuring that all charge review edits are appropriately resolved in charge review work queues to file clean, accurate claims, utilizing claim judgement and critical thinking skills.  3. Follows charge reconciliation processes to ensure all charges are being captured for all providers.  Verifies all information required to produce and 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.  Ensure compliance with Teaching Physician guidelines within an academic medical practice.4. Pends charge sessions to seek corrective action for services not meeting documentation requirements in accordance with YMA policies and procedures.  Identifies that a provider should be contacted to clarify or amend a medical record, following communication and escalation procedures.  Modifies clinician's selection.  Exercises independent judgement and decision making on a regular basis with respect to all codes selected, applying critical thinking skills.  Draws valid conclusions to support decision.  Identifies provider issues that are trending and escalate per policy to minimize rejections and audit risk that could result in substantial financial costs to the department and school.5. Adheres to YMA policies and procedures and Yale Medicine's Mission, Values and Guiding Principles.  Active participation in team and department training and education programs and staff meetings.  Establish and cultivate productive relationships among staff to support a positive team environment and professional interactions.  Maintain professional and technical knowledge by participating in educational workshops and reviewing professional publications.  6. Works with manager or designee to identify educational opportunities for colleagues and providers, as well as system edits to enhance accuracy and productivity within Epic.  Perform independent research using available digital and website resources to provide recommendations for coding, billing, and documentation questions when escalation is indicated.7. May perform other duties as assigned.

Required Skill/ability 1:  Demonstrated ability to apply critical thinking skills. Comprehensive knowledge of ICD-10, CPT, HCPCs and modifier coding, medical terminology, human anatomy, and digital coding resources/software. Ability to analyze and interpret evaluation & management documentation guidelines and surgical procedure reports, diagnostic studies, pathology, and labs.

Required Skill/ability 2:  Proficiency with electronic health record and practice application systems, electronic data entry and retrieval, and web-based applications and websites. Intermediate proficiency with MS Word, Excel, Outlook (emails and calendars), Zoom and PowerPoint.

Required Skill/ability 3:  Demonstrated ability to independently perform all categories of coding/billing work, including all aspects of surgical coding. Comprehensive knowledge of Federal payer regulations, third party payers, HIPAA rules, reimbursement policies and procedures and Teaching Physician Guidelines within an academic medical practice. Proven ability to interpret and apply guidelines

Required Skill/ability 4:  .Demonstrated ability to train others & to assist in QA process across multiple service lines. Demonstrated strong interpersonal, verbal, & written communication skills. Effectively communicate with team members to resolve questions on assignments. Effectively communicate with providers, following escalation processes with analytics team & manager

Required Skill/ability 5:  Ability to work independently with a high level of proficiency, accountability, and productivity. Organize and prioritize work with minimal supervision, as well as others as assigned. Ability to work in a fast-paced environment meeting timely deadlines while maintaining high productivity and quality standards. Ability to work effectively as a team member with common goals.

Preferred Education:  Additional specialty coding credential.

Work Week:  Standard (M-F equal number of hours per day)

Posting Position Title:  Medical Coding and Billing Assistant 2

University Job Title:  Medical Coding and Billing Assistant 2

Preferred Education, Experience and Skills:  Additional specialty coding credential.

Six years of related work experience, four of them in the same job family at the next lower level, and a high school level education; or four years of related work experience and an Associate degree; or little or no work experience and a Bachelor degree in a related field; or an equivalent combination of experience and education.

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