Reimbursement/HIM Specialist, PACE-CNY at Loretto in Syracuse …

Conducts initial reviews of various medical record documentation to ensure the capture of all appropriate diagnoses/procedures related to reimbursement and compliance standards.


Abstracts outcome data as required by accrediting, regulatory, and voluntary agencies such as CMS, DOH, and NPA (National PACE Association).  Completes weekly checks to monitor for CMS and DOH guideline changes related to risk adjustment information.


Routinely reviews medical record information and coding to identify appropriateness based on CMS HCC categories.


Assures the accuracy, completeness, specificity and appropriateness of diagnosis information.


Verifies and ensures the accuracy, completeness, specificity and appropriateness of diagnosis codes based on services rendered.


Identifies trends/problems in medical documentation and recommends solutions to the Health Information Director/designee.


Provides education and training regarding provider documentation via daily interaction with providers and other suitable training modalities to ensure capture of all applicable diagnoses/procedures related to reimbursement and compliance standards; writes monthly education newsletters.  Reports any trends and/or issues to the Health Information Director/designee.


Identifies medical services provided but not adequately documented in medical record.  Advises supervisor and clinicians of deficiencies to ensure accuracy, completeness and capture of maximum reimbursement.


Prepares provider profiles on a monthly basis, prepares utilization and various statistical reports and in collaboration with Health Information Director/designee assists in analyses as appropriate; acts as back up person for completion of risk adjustment reports.


Monitors compliance with procedures relevant to clinical data management; conducts monthly audits to monitor for the accuracy of clinical coding by PACE CNY providers and outside providers via hospital bills, etc. as part of the PACE CNY’s compliance program.  In conjunction with PACE CNY finance department, assist with claims analysis on incoming participant medical invoices; works closely with PACE CNY finance department to ensure compliance with CMS submittal guidelines for all outside medical encounters.


Keeps current with coding and reporting requirements and performs all necessary duties to maintain compliance.  As needed accurately completes diagnostic and procedural coding for PACE clinic providers based on clinical documentation.  Ensures timely processing and submission of encounter forms in order to comply with CMS & DOH timelines; also completes ancillary encounter diagnostic and procedural coding based on provider documentation as needed.


Reviews questionable or denied claims from PACE CNY contracted providers.  Completes medical chart review related to such claims and provides feedback to the Health Information Director/designee.


Keeps current on Correct Coding Initiative Edits and works with the PACE CNY finance department to ensure the adjudication system is updated appropriately.


Updates PACE CNY and McAuliffe encounter forms yearly and as necessary as new codes become available.


Acts as a resource for PACE CNY, the Loretto Geriatric Center Licensed Home Care Agency and various Loretto finance departments for reimbursement, compliance, and coding issues.


Completes audits related to reimbursement coding compliance, utilization management and QA related to record maintenance and Health Information releases on an ongoing basis.  Trends audit results and provides reports to the Health Information Director/designee.


Actively participates in staff meetings or other meetings as requested by supervisor.  Assists as requested in relevant committees, task forces and special projects to promote quality improvement initiatives.


Checks new enrollees’ initial visit provider diagnoses list versus diagnoses contained in old records to confirm the carry over of appropriate preexisting diagnoses.  Brings discrepancies to the provider’s attention.


Complete monthly statistical/demographic reports and distribute to appropriate personnel.


Conducts in-service programs relating to health information and/or reimbursement as required.


Provide assistance and back up help as requested to other areas of the Health Information Department.


Performs podiatry coding for McAuliffe ancillary department, meets with provider to review coding questions; providers ongoing education regarding coding changes/expectations/documentation requirements.


Demonstrates adherence to all compliance policies and procedures and the code of conduct.

Displays compliance oriented behavior in the workplace.  Is responsible for promoting and fostering compliance in the workplace.  Adheres to the mission and philosophy of the D & TC, PACE CNY and the Loretto Corporation.



Adheres to service excellence by developing and maintaining positive respectful relationships will all customers, internal and external, to include participants, families, team members, all staff throughout the organization and community partners; performs responsibilities according to the highest quality standards.


Performs other duties as assigned.


Employer’s Disclaimer:


■    All requirements are subject to possible modification to reasonably accommodate 

      individuals with disabilities.


■    Employees will be required to follow any other job-related instructions and to perform any

      other job-related duties requested by their supervisor.


■    This document does not create employment contract, implied or otherwise, other than an

      “at will” employment relationship.


■    This job description in no way states or implies that these are the only duties to be

      performed by the employee occupying this position.


Created:    10/12

RefactorU becomes one of first coder schools to gain Colorado …

RefactorU becomes one of first coder schools to gain Colorado licensure

BOULDER – RefactorU LLC, a boot camp for software developers that launched in Boulder last year, has become one of the first two such schools in the state to receive provisional licensure from the Colorado Division of Private Occupational Schools, warding off the possibility of legal action by the state.+

The issue of developer, or coder, schools attaining licensure first rose to prominence in California early this year when state officials sent several boot camps there cease-and-desist letters, threatening closure or large fines if the schools didn’t come into state compliance. RefactorU logo+

Colorado’s DPOS began looking into coder schools here earlier this year in the wake of the California events. The boot camps have risen in prominence lately as they try to help fill the tech industry’s ever-increasing demand for software developers, who can make $60,000 per year and up in starting salary.+

Colorado law stipulates that any for-profit or not-for-profit entity that offers educational credentials or “educational services constituting occupational education” must attain licensure from the DPOS.+

Sean Daken, founder and chief executive of RefactorU, said he didn’t believe Refactor fell under the statute at first because he believed it was only for schools that covered occupations requiring certification for employment, such as massage therapy. But he said RefactorU was happy to comply upon becoming aware that it was not in fact exempt from the statute.+

“We didn’t have all the details when we first started RefactorU,” Daken said.+

The DPOS oversight is in place to make sure private occupational schools meet minimum standards and ensure students get the training and services they’ve bargained for.+

SeedPaths, a boot camp in Denver focused on helping low-income youth learn development skills, is the other Colorado coder school to receive initial licensure so far. Lorna Candler, director of the DPOS, said Louisville-based DaVinci Coders and Galvanize’s g-School – which has boot camps in Denver, Boulder and, soon, Fort Collins – are both going through the licensing process.+

“We’re kind of trying to keep our eye on that area as it seems to be emerging,” Candler said.+

Among the hurdles RefactorU had to clear to gain licensure was lots of documentation about the coursework offered and a site approval. The school also had to attain a surety bond in the amount of one cohort’s tuition. If the school were to go out of business during a session, the DPOS would be able to make a claim on the bond to refund students or enroll them in other programs.+

Given the cost of the bond, Daken said the licensure was no doubt costly. RefactorU charges $13,500 per student for each 10-week cohort, which each contain about 20 students. But he said it was something that RefactorU wanted to do, and could eventually help the school attain further accreditation down the road.+

“We’re doing this because we want to be good corporate citizens and because we want to make sure our students are protected,” Daken said. “But also because it’s the first step in that accreditation process.”+

The provisional licensure lasts one year. Assuming RefactorU and SeedPaths stay in compliance, they’ll be able to reapply for a three-year renewal.+

Candler said schools that don’t comply can be faced with the DPOS filing cease and desist orders.+

“We try to give them the opportunity to cure before we initiate any legal proceedings,” Candler said. “I think a lot of them don’t know that they need to be regulated. If they don’t come into compliance, then we try to kick it into a legal format.”+

Follow Josh on Twitter: @JoshLindenstein+

Ways To Obtain a Medical Billing and Coding Certification | Medical …

One of the promising careers in the medical industry is that of medical billing and coding professional. However, before you can legitimately practice this profession, you have to get a medical billing and coding certification. The future of this career is bright because every year, the government and the health insurance industry are requiring more accurate and specific diagnoses and treatments of patients.

You can obtain the medical billing and coding certification in several ways. But before you choose any institution that offers these programs, you must be sure that they have high standards of instructions and are fully accredited by the government and medical institutions. This will ensure that your efforts will produce results and will not just go to waste.

Medical Billing and Coding Certification Overview

Essentially, the medical billing and coding certification is your proof that you have undergone the necessary education and training required to accurately code and bill patients’ diagnosis and treatments. These codes are used by doctors and health insurance companies to properly identify the services done to a patient and accurately assess or bill the amount of services that should be paid to the medical provider. There are no standard ways of instructions in this field, but most medical employers such as hospitals, clinics, and medical centers are looking for those who are certified by their accredited educational institutions.

How to Obtain Certification

There are four ways you can be certified. Your present level of education will be a factor in choosing the most effective way to obtain the medical billing and coding certification. The following are some of the ways to acquire certification to help you decide which one will be the best course for you to take.

1. Take a BA program
One option is to enroll in a Bachelor of Arts course on health information and management. Statistics coming from an AAPC survey show medical coders and billers possessing BA degrees earn about $51,389 annually. This is higher than those who only have acquired technical school degrees.

2. Take a study course leading to a medical billing diploma
This is the most affordable way of getting certified. It is a six-month course and only requires a high school education to enroll. The course will only cost you a few hundred dollars. You can take them in community colleges, medical billing schools and online.

3. Take a two-year associate program
These programs provide more in-depth coding and billing education and training. It is more expensive than the first option, but it is a better investment of your time and money. You may have to spend a few thousand dollars but it will be worth it because medical associations like AHIMA (American Health Information Management Association) only accept those who have associate degrees for certification.

4. Take an online course
Online courses leading to bachelor and associate degrees for medical billing and coding are also available online. These courses are more convenient to take since you can do it on your own time. This is also a less expensive way of obtaining medical billing and coding certification compared to those being offered by educational institutions.

All are good ways help you achieve your goals and jump start your new career as medical coder and biller.

Medical Coder at CARTI in Little Rock, AR |

From Marketer to Coder – The Denver Egotist

People always ask me why I made the switch from marketing to writing code.

Often, when it’s coming from a Marketer, the question is posed with an obvious tone of incredulousness. Like why in the hell would I want to spend my days looking at that horrible black screen, tucked away in a dark room, just a hair’s breadth away from turning into Gollum. The fear and loathing is unmistakable. And then sometimes, when the question is posed by a Coder, there is an air of distrust and skepticism. Like I am out to eat their young, or an evil secret double-agent, or simply that I am just a hair’s breadth away from certifiable cuckoo.

So here is the thing – I didn’t wake up one morning and decide, oh, I think I’ll go do that programming thing now. I’d already done with that law school and it only amounted to a law degree, bar certification, and annual dues I pay as a permanently “inactive attorney”. My desire wasn’t to change careers and become a full-fledged coder. As a marketer, with a solid career in brand strategy, digital communication planning, project/account management, and campaign leadership to name a few… I didn’t have that much to complain about. I had worked agency and client side both, and was focused on growing my resume and climbing the executive ladder.

But to keep my edge, and increase my value in the space, I felt like I needed to brush up on my tech literacy, specifically in the nitty-gritty details of actual coding. I felt like I was losing my ability to communicate effectively with developers because there was so much that I didn’t understand about their actual day-to-day work, which was work that I desperately depended upon.

Also – The Aha Method needed a website, and Kat and I were not in a position to bankroll that project. Fortunately for me, I had a host of very close friends who were developers and a few that were willing to mentor. And so I started slow. Just a little coding work and pairing sessions every week on building a tiny little static site. It took me three months at that rate, which was excruciating, because I knew my mentor could have built it in a day. But once it was done, and I pushed it live… holy shit. No past marketing campaign that I lead, not even three Super Bowl campaigns combined, could measure up to the feeling of satisfaction in that one little accomplishment. Because I had built it. Because marketing a product now paled in comparison to actually building a product. And I wanted to do more of THAT. So began my journey into a formal career change.

Luckily, I found Jumpstart Lab, which is now Jeff Casimir and the rest of his crew developed a six month, highly intensive and immersive program for taking those with no prior programming experience and turning them into real-live coders. I enrolled and was accepted. It was much harder than law school. It was a kick-in-the-teeth-humbling-experience in which I was pretty much failing for the first three months. I’ve always been a quick study and good at anything I put my mind to, but programming wasn’t something to be ‘conquered’ as I would discover. In her post, “Don’t Believe Anyone Who Tells You Learning To Code Is Easy”, I think Kate Ray most aptly describes what it means to learn to code and become a legitimate programmer:

“… there is no mastery, there is no final level. The anxiety of feeling lost and stupid is not something you learn to conquer, but something you learn to live with.”

And for as many times as it made me cry and doubt myself in those early months, the fact that programming isn’t something to be checked off some proverbial list – is exactly its appeal. It is truly constant learning and constant feedback. Progress is incremental, tangible, and deeply satisfying. It is a lesson in keeping things small and celebrating the cumulative wins.

And shit breaks – a LOT, which is a constant reminder to practice humility and don’t give up. Honestly – its made me a better mother if you can believe that. How I interact with and teach my son has been influenced by what I’ve learned in programming. We pair build legos in a whole new way, and it’s RAD.

So here is where I’m really going with all this, and that is that we need more developers with diverse backgrounds, hailing from all professional walks of life. There are a lot of opinions about what it takes to be a coder, including logic, problem solving, attention to detail, to name a few. And while those are valid and true, cultivating other aspects like passion, creativity, and even humor, are incredibly important. And you don’t have to be a math or computer science major to write beautiful code that works. The marketplace is in need of more developers (desperately), but it is also in need of innovation, new design thinking, and some fresh perspective from people with diverse experience.

I would challenge all of you in Ad-Agency-Land who don’t write any code, to begin an investigation in writing code, even if just for the sake of understanding the world around you a little better, or to communicate more effectively with your coder-colleagues. Whether you simply task yourself with understanding how the internet really works, or you dive head first into writing your own applications, both are valuable and can be key to positioning you for growth in almost any aspect, be that marketing or parenthood. Seriously.

Here are some good places to start:

• Turing Community Meetup in Denver: Free beginner classes.

• Jumpstart Lab Tutorials Online: Excellent set of Ruby on Rails tutorials

• Code School: Online courses

This editorial is cross-posted from Aha Method’s The BRAT Blog.