Payment Policy, Coding & Reimbursement Associate

Location

Rosemont, Ill.

Status

Exempt

Reports To

Health Policy, Quality, and Reimbursement Director

Overview

The Payment Policy, Coding and Reimbursement Associate’s primary responsibilities include monitoring payer policies; handling code changes and guidelines; contribution to and maintenance of the association’s dental and medical coding and billing resources and courses; assisting members with their dental and medical coding and billing needs; and staff support to the AAOMS Committee overseeing all items mentioned. To accomplish these tasks, this Associate must possess extensive knowledge of ICD-10-CM, CPT, and CDT coding systems and their relation to physician and dentist reimbursement. Therefore, this position requires experience with procedural and diagnostic coding systems; understanding the relation to physician reimbursement; comfort with research and writing; and proficiency in health policy analysis.

Monitoring Payer Policies:

The Payment Policy, Coding and Reimbursement Associate will monitor and research state insurance codes as well as Federal and commercial payer policies to stay abreast of coding and/or reimbursement policy changes and laws that affect oral and maxillofacial surgeons. This position will prepare written summaries of such policies as they relate to or impact oral and maxillofacial surgery as well as prepare written comments to CMS and other agencies that implement policy changes.

Monitoring Code Changes and Coding Guidelines:

The Payment Policy, Coding and Reimbursement Associate will actively participate in the AMA and ADA committees that oversee code development and valuation of CPT and CDT procedure codes. Attendance at these committee meetings will be required. This position will also monitor ICD-10-CM code changes and industry discussions regarding the implementation of ICD-11-CM in the United States.

Contribution and Maintenance of Coding & Billing Resources and Courses:

The Payment Policy, Coding and Reimbursement Associate will write health policy content for AAOMS newsletters and AAOMS website. This position will also contribute to the development, planning, and presentation of the AAOMS’ in-person and online coding and billing courses. Attendance at the in-person workshops will be required in order to provide on-site staff support.

Member & Committee Assistance:

Member assistance may include but not limited to, guiding members with proper code selection; deciphering reimbursement policies and/or assistance with troubleshooting claim denials. This Associate must stay abreast of code changes and coding edits; third-party payer coverage policies; Medicare and Medicaid policies; and changes and/or policies affecting medical and dental claim filing. The Payment Policy, Coding and Reimbursement Associate also provides year-round staff support to the Committee on Health Care Policy, Coding, and Reimbursement including assistance with coordinating committee projects, handling committee meeting logistics, and assistance with preparing meeting / conference call agendas and meeting minutes.

Key Accountabilities

Qualification

• Ability to handle complex coding and billing issues
• Excellent organizational, time and project management skills
• Knowledge of Current Procedural Terminology (CPT) and Current Dental Terminology (CDT) coding systems and Internal Classification of Diseases (ICD) coding system
• Knowledge of medical and dental terminology and physiology
• General knowledge of OMS, medical or dental clinical practice, specific familiarity with frequently utilized procedures
• Experience with policy research, data analysis, electronic health records, and practice management
• Knowledge of government and private payor policies
• Understanding of basic marketing skills
• Must be able to lift up to 50 lbs.
• Ability to travel, up to 10%