TITLE: Billing and Coding Analyst
DIVISION: CMA Physician Services Organization (CMA-PSO)
REPORTS TO: Chief Strategy Officer
OFFICE LOCATION: California-based remote
EXEMPTION STATUS: Exempt
The CMA-PSO is looking for a Billing and Coding Analyst to help facilitate transformative change within primary and/or specialty care practices or community health centers. As a Billing and Coding Analyst, you will be responsible for assessing our service vendor partners and partner-practice billing and coding workflow, devising training and materials, facilitating corrective actions, and conducting audits and medical chart reviews.
The Billing and Coding Analyst is expected to offer subject matter expertise to the CMA-PSO's team, our service vendor partners and partner-practices. The ideal candidate will be a certified coder, have an empathetic coaching style and strong experience presenting to stakeholders at various levels in organizations and medical offices.
- Assess billing/coding workflows to identify coding, charge capture, and risk assessment areas of improvement within the practice.
- Performs documentation and coding assessments, as well as understanding of related billing practices including CPT-4, ICD-9 and ICD-10, medical procedures, and patient encounters by clinical service providers (physicians) and hierarchical condition category (HCC) coding
- Conduct audits of practice charts to assess compliance, completeness, and consistency with value-based care goals.
- Advise on best practices for billing and coding to improve workflow on coding documentation for physicians and providers.
- Maintain up-to-date billing standard knowledge for both Federal and California payers.
- Conduct chart reviews as related to Merit-Based Incentive Payments (MIPs) reporting and help to report results for the Medicare Shared Savings Program (MSSP).
- Offer consultation to CMA-PSO practice transformation specialists, service vendor partners, and independent medical practices, providing detailed assessment and recommendations for full adoption of value-based billing and coding practices.
- Manage multiple projects at various stages efficiently and independently.
- Present to audiences ranging from practice leadership/executives to front-line staff, influencing adoption of best practices and materials that orient to our service vendor partner and practice partner needs.
- Training proficiency in delivering detailed but concise training content on complex material to multiple client stakeholders.
- Support/Coach partner practices through change management.
- Align with multidisciplinary internal teams to ensure progress towards the shared goal of supporting practices from kick-off to go-live.
- Biller/coder certification is required.
- Experience conducting chart reviews for MIPS reporting is required.
- Bachelor’s degree from an accredited college or university is required. Master’s degree and/or project management certification a plus.
- Based in California and willing to travel up to 30% time within the state. (Note: During COVID-19, it is expected that all work will be remote, requiring virtual work and visits)
- At least two (2) years of health care billing/coding experience is required, four (4) or more years are strongly preferred.
- Ability to effectively communicate and maintain a professional, coaching approach with partner practices.
- Excellent organizational skills.
- Ability to manage multiple projects and activities on a routine basis, with minimal supervision.
- Excellent computer skills and experience working with a wide range of software applications including, Excel, Salesforce, Visio, Tableau, and Google and other web conferencing platforms.
(This job description reflects the general level and nature of the job. It is not intended to be all inclusive.)