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 workqueues.  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 workqueues 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 Skill/ability 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.

Required Skill/ability 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).

Required Skill/ability 3:  Demonstrated knowledge of Federal payer regulations, third party payers, HIPAA rules, reimbursement policies and procedures. Proven ability to interpret and apply guidelines.

Required Skill/ability 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.

Required Skill/ability 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 within an academic medical environment or large multi-specialty practice; CPC certification preferred.

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

Posting Position Title:  Medical Coding and Billing Assistant 1

University Job Title:  Medical Coding and Billing Assistant 1

Preferred Education, Experience and Skills:  Experience within an academic medical environment or large multi-specialty practice; CPC certification preferred.

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

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