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Requisition Number 18-0014
Title Coding & Billing Analyst 1, 2 or 3 - Ophthalmology
Location UVA Medical Center
City Charlottesville
State VA
Hours per week Full time
Description POSITION TITLE: Coding & Billing Analyst I
JOB CODE: B3121
LEVEL/FLSA: Level 10, Non-exempt
DEPARTMENT: Various Administrative or Clinical Departments, UPG
REPORTS TO: Department Supervisor

GENERAL SUMMARY: The incumbent is responsible for developing and maintaining policies and procedures to ensure the timely, accurate, and comprehensive charge capture and billing of all physician services in the respective clinical department. The incumbent monitors billing and collections performance and recommends corrective action to address deficiencies in a manner that optimizes reimbursement. Positions may vary in assignments depending on proficiency of specialties and departmental needs.

PRINCIPAL DUTIES AND RESPONSIBILITIES:
Essential Functions of the Job:
 Develops and maintains policies and procedures to enhance the efficiency of the capture, coding, and submission of all physician charges.
 Reviews and recommends changes to charge capture documents to ensure appropriate utilization of up-to-date procedure and diagnosis codes.
 Reviews and recommends department's support files in the billing system, related to the addition/deletion of divisions, physicians, procedure codes, and fees.
 Reviews and analyzes fee levels for physician services on a periodic basis, and recommends changes to Manager.
 Monitors and analyzes management information reports to identify variances in billing productivity and reimbursement performance. Recommends corrective action to address deficiencies.
 Meets with staff on a regular basis to review clinical billing and collections performance, and discuss third payor reimbursement issues.
 Develops and conducts new training to support effective billing of physician services.
 Acts as liaison between the clinical department, the Health Services Foundation, and UVA Hospital on issues.
 Assists with the capture, coding, and submission of charges to the billing system, including resolution of carrier rejects/denials.
 Acts as coding/billing and reimbursement resource and disseminates information on new insurance/billing procedures to rest of staff.
 Provides assistance with other patient billing responsibilities, including resolving patient requests, providing price quotes, attending billing and reimbursement meetings.
 Performs other duties as requested by Supervisor.


POSITION TITLE: Coding & Billing Analyst II
JOB CODE: B3122
LEVEL/FLSA: Level 11, Non-exempt
DEPARTMENT: Various Administrative or Clinical Departments, HSF
REPORTS TO: Department Supervisor

GENERAL SUMMARY: The incumbent is responsible for monitoring, communicating and training physicians and clinic staff on all coding and billing policies and procedures established in the clinical department, HSF Administrative Unit, the UVA Health System and governmental and other insurance carriers. The Analyst is the liaison to the clinical staff for all billing related issues that includes charge capture, CPT-4/ICD-10 coding and third party billing guidelines. Positions may vary in assignments depending on proficiency of specialties and departmental needs.

PRINCIPAL DUTIES AND RESPONSIBILITIES:
Essential Functions of the Job:
 Reviews medical documentation on a prospective (prior to billing) and regular basis to determine if documentation supports the service being billed in accordance with coding and compliance guidelines and the appropriate third party regulations and /or standards.
 Prepares written reports of review results and present the results to management and physicians.
 Meets with physicians on a regular basis to review coding and billing performance and offers support to resolve any coding and billing question.
 Conducts physician training sessions to support effective billing of physician services, including annual training for all new fellow/residents.
 Perform periodic reviews of outpatient billing and consult service. Analyses and resolves any documentation issues as necessary.
 Oversees the implementation of semi-annual front desk office staff training.
 Monitors billing procedures to ensure timely and accurate charge capture and submission, appropriate payment posting and to ensure other related billing procedures are performed.
 Serve as a liaison between all UVA Health System entities in an effort to facilitate reimbursement issues (i.e. Registration, Hosp/Physician billing, Coding)
 Identifies, analyzes and resolves front-end system issues within the department.
 Monitors and analyzes charge rejects/denials from the Health Services Foundation and insurance carriers. Identifies trends and problem areas and recommend corrective action in billing policies and procedures to address deficiencies.
 Maintains charge capture documents to ensure appropriate utilization of up-to-date procedure and diagnosis codes.
 Monitors and analyzes management information reports to identify variances in physician billing productivity and reimbursement performance. Recommends corrective action to address deficiencies.
 Assists Business/Billing Manager with the implementation of new policies and procedures to enhance the efficiency and accuracy of the capture, coding, submission and reimbursement of all physician charges to the Health Services Foundation.
 Provides lead expertise to other billing staff related to coding, billing and reimbursement policies and procedures.
 Assigns appropriate ICD-10 diagnosis codes. Determines which CPT-4 codes can be charged, according to generally accepted coding guidelines.
 Assists keying charges to appropriate management system.
 Conducts regular A/R and collections analyses, including audits on particular departments and payors.
 Oversees charge capture process by resolving daily operation questions and problems that arise in the supervisor’s absence.
 Assists and supports supervisor with staff training, system and procedure implementation as required and completes other assignments as required.

POSITION TITLE: Coding & Billing Analyst III
JOB CODE: B3123
LEVEL/FLSA: Level 12, Non-exempt
DEPARTMENT: Various Administrative or Clinical Departments, UPG
REPORTS TO: Department Supervisor

GENERAL SUMMARY: The incumbent is responsible for monitoring, communicating and preparing materials for physician documentation reviews and departmental coding staff reviews in preparation for all Billing Quality Educators to train providers and coders on all coding and billing policies and procedures established in the UPG Administrative Unit, the UVA Health System and governmental and other insurance carriers. Incumbents typically responsible for advanced assignments depending on proficiency of specialties and departmental needs.

PRINCIPAL DUTIES AND RESPONSIBILITIES:
Essential Functions of the Job:
 Reviews medical documentation on a prospective (prior to billing) and regular basis to determine if documentation supports the service being billed in accordance with coding and compliance guidelines and the appropriate third party regulations and /or standards.
 Prepares written reports of review results and present the results to the Billing Quality Educators.
 Meets with Educators on a regular basis to review coding and billing performance and offers support to resolve any coding and billing question.
 Assist in conducting physician training sessions to support effective billing of physician services, including annual training for all new fellow/residents.
 Serve as a liaison between all UPG Billing & Collections and Billing Quality Educators in an effort to facilitate reimbursement issues (i.e. Registration, Hosp/Physician billing, Coding)
 Identifies, analyzes and recommends resolution of front-end system issues within the various clinical departments.
 Monitors and analyzes -22 modifier denials from insurance carriers. Identifies trends and problem areas and recommends corrective action in documentation standards, billing policies and procedures to address deficiencies.
 Monitors and analyzes management information reports to identify variances in physician billing productivity and reimbursement performance. Recommends corrective action to address deficiencies.
 Assists Business/Billing Manager with the implementation of new policies and procedures to enhance the efficiency and accuracy of the capture, coding, submission and reimbursement of all physician charges to the UVA Physicians Group.
 Assigns appropriate ICD-10 diagnosis codes. Determines which CPT-4 codes can be charged, according to generally accepted coding guidelines.
 Conducts requested prospective documentation and coding audits on particular departments/providers and payors.
 Assists and supports supervisor with system and procedure implementation as required and completes other assignments as required.

SUPERVISORY RESPONSIBILITIES: This position may supervise 1 or 2 lower level Coders, and may act in a team lead or project lead capacity, and may provide training to others.

WORKING CONDITIONS: General busy clinical office environment

SUCCESS FACTORS:
 Thoroughness and dependability
 Detail orientation
 Good organizational and analytical skills
 Strong oral and written communication skills
 Must be willing to maintain professional certification and keep current with changes in procedure and diagnoses coding and third-party payor reimbursement policies through continuing education
 Required to attend coding seminars and meetings to keep abreast of changes in the profession
 Ability to manage multiple tasks in a busy office environment
 Exceptional customer service skills
 Ability to effectively communicate and work with physicians, staff and management
 Ability to work with and maintain confidentiality of patient and patient account data
 Ability to work as a team member

We are an Equal Opportunity Employer



Requirements REQUIRED QUALIFICATIONS (Knowledge, Skills & Abilities): (Analyst 1)
Education:
 High School Diploma or GED
Experience:
 Professional Coding Certification with 3 years of Coding experience, or 7 years of Coding experience.
 If using a CPC, must be certified AAPC or CCS-P through AHIMA to qualify for all functional areas.
 In depth knowledge of CPT-4 and ICD-10 coding. Must know modifiers, and use of local policies.
 In-depth knowledge of third-party payer reimbursement policies and procedures.
 Familiarity with IDX and A2K3 preferred.
Knowledge and skills:
 Basic knowledge of and experience utilizing a personal computer.
 Basic word processing, spreadsheet, and database software skills required.
 Must have experience creating spreadsheets, reports, and trends data.
 Must demonstrate the ability to both prepare and analyze data as determined by management.
 Demonstrated ability to implement and execute multi-task assignments independently.
 Demonstrated ability to serve as a preceptor for special projects.


REQUIRED QUALIFICATIONS (Knowledge, Skills & Abilities): (Analyst II)
Education:
 High School Diploma or GED
 College courses in business-related field
Experience:
 Five years of experience in coding/billing position
 Must be CPC Certified by AAPC or CCS-P through AHIMA to qualify for all functional areas
 In depth knowledge of CPT-4 and ICD-10 coding
 In-depth knowledge of third-party payor reimbursement policies
 Must know modifiers and use of local policies
 Experience in a multi-specialty, academic, tertiary care physician practice a plus
 Experience providing training and guidance in coding a plus
Knowledge and skills:
 Intermediate knowledge of and experience utilizing a personal computer
 Intermediate word processing, spreadsheet, and database software skills required
 Familiarity with IDX and A2K3
 Must demonstrate the ability to both prepare and analyze data as determined by management
 Demonstrated ability to implement and execute multi-task assignments independently
 Demonstrated ability to serve as a preceptor for special projects, systems preferred


REQUIRED QUALIFICATIONS (Knowledge, Skills & Abilities): (Analyst III)
Education:
 High School Diploma or GED
 College courses in business-related field
Experience:
 Eight years of experience in a coding/billing position
 Must be CPC Certified by AAPC or CCS-P through AHIMA to qualify for all functional areas
 In depth knowledge of CPT and ICD-10 coding
 Ability to prepare materials on Physician documentation and coding staff reviews to support related Billing Quality Educator training and policy setting.
 In-depth knowledge of third-party payor reimbursement policies
 Must know modifiers and use of local policies
 Experience in a multi-specialty, academic, tertiary care physician practice a plus
 Experience providing training and guidance in coding a plus
Knowledge and skills:
 Intermediate knowledge of and experience utilizing a personal computer
 Intermediate word processing, spreadsheet, and database software skills required
 Familiarity with IDX and A2K3 systems preferred
 Must demonstrate the advanced ability to both prepare and analyze data as determined by management
 Demonstrated advanced ability to implement and execute multi-task assignments independently
 Demonstrated advanced ability to serve as a preceptor for special projects


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