Clinical Reimbursement Manager
: Job Details :

Clinical Reimbursement ManagerJob No: 495723 Department: Corporate Compliance Office Local Title: Clinical Reimbursement Manager Budget Title: Assistant for University Financial Analysis Work Type: Full Time Location: Brooklyn, NY Categories: Management and Professional, AdministrativeAre you looking to take your career to new heights with a leader in healthcare? SUNY Downstate Health Sciences University is one of the nation's leading metropolitan medical centers. As the only academic medical center in Brooklyn, we serve a large population that is among the most diverse in the world. We are also highly-ranked by Castle Connolly Medical, a healthcare rating company for consumers, among the top 5 leading U.S. medical schools for training doctors.Bargaining Unit:MCJob Summary:The Office of Compliance and Audit Services at SUNY Downstate Health Sciences University is seeking a full-time Clinical Reimbursement Manager / Assistant for University Financial Analysis. The successful candidate will:

• Perform auditing patients' medical records, online/or paper based, for each department, in accordance with the annual work-plan.
• Review E/M inpatient and outpatient records for University Hospital at Downstate and Clinical Practice Management Plan (CPMP) providers, including Emergency Room and Telehealth records, based on the applicable Evaluation & Management guidelines.
• Perform periodic auditing of:
  • Diagnosis Related Groups (DRG) validation for inpatient cases;
  • Ambulatory Payment Classification (APC) and Ambulatory Payment Groups (APG) validation for ambulatory/outpatient cases.
• Request additional information from administrators, when needed, for accurate auditing.
• Schedule clarification meetings with providers.
• Evaluate provider performance by analyzing and interpreting data and metrics, and prepare statistical reports for all cases reviewed for each service.
• Prepare and review Drafty Audit Reports and provider grids prior to distribution.
• Research various topics related to coding and documentation in order to provide accurate and pertinent information to applicable department administrators, Directors/Chairs, physicians and coders.
• Prepare training materials on various topics and schedule training sessions for providers based upon new/revised requirement or audit outcomes.
• Assist in the standardization of institutional policies, practice workflows, and data reporting.
• Keep abreast of all updates to hospital and physician electronic record systems.
• Collaborate with mid-level management and IT representatives to align EMR processes with coding and documentation requirements and participate, as needed, in operational and IT related meetings.
• Keep abreast of all coding and documentation updates, including CMS and Medicaid guidelines, ICD-10-CM/PCS, CPT and coding clinic updates, etc.
• Respond to coding and documentation inquiries, as requested.
• Participate and manage special projects, as assigned by the Clinical Reimbursement Compliance Director and/or the VP of OCAS.

Required Qualifications:

• Bachelors Degree.
• Certification in ICD-10-CM and CPT coding.
• Efficiency in Microsoft Word, Excel, and PowerPoint.

Preferred Qualifications:

• CCS or CCS-P preferred.
• 5 years of experience in a teaching facility preferred.

Work Schedule:Monday to Friday; 9:00am to 5:00pmSalary Grade/Rank: MP4Salary Range: Commensurate with experience and qualificationsCOVID-19 Vaccination Requirement: An approved COVID-19 vaccination.Executive Order:Pursuant to Executive Order 161, no State entity, as defined by the Executive Order, is permitted to ask, or mandate, in any form, that an applicant for employment provide his or her current compensation, or any prior compensation history, until such time as the applicant is extended a conditional offer of employment with compensation. If such information has been requested from you before such time, please contact the Governor's Office of Employee Relations at (518) ###-#### or via email at ...@goer.ny.gov.Equal Employment Opportunity Statement:SUNY Downstate Health Sciences University is an affirmative action, equal opportunity employer and does not discriminate on the basis of race, color, national origin, religion, creed, age, disability, sex, gender identity or expression, sexual orientation, familial status, pregnancy, predisposing genetic characteristics, military status, domestic violence victim status, criminal conviction, and all other protected classes under federal or state laws.Women, minorities, veterans, individuals with disabilities and members of underrepresented groups are encouraged to apply.If you are an individual with a disability and need a reasonable accommodation for any part of the application process, or in order to perform the essential functions of a position, please contact Human Resources at ...@downstate.eduAdvertised: January 26, 2023 Eastern Standard Time Applications close: