Summary:
Reviews and Resolves coding and charging issues preventing posting of revenue and release of claims.
Coordinates changes in charge capture workflows and communicates changes to organization.
Works with Epic ancillary teams as well as clinical teams to establish consistent charge flow throughout the medical center.
Uses comparative reporting to monitor revenue and usage departmentally.
Is responsible for resolving coding/billing edits in the EPIC work queues in a timely manner.
Participates in quality assessment and continuous quality improvement activities.
Complies with all appropriate safety and infection control standards.
Performs all job duties and responsibilities in a courteous and customer-focused manner according to the Hurley Family Standards of Behavior.
Requirements:
• Bachelor's degree in Accounting, Business, or related field.
• Two (2) years of health care experience with third-party payer reimbursement activities, or supervisory experience of staff assigned to facility billing in a hospital/medical center setting, or supervisory experience of staff responsible for charge master accounts.
-OR-
• Associate's degree in Accounting, Business, or related field.
• Four (4) years of health care experience with third-party payer reimbursement activities, or supervisory experience of staff assigned to facility billing in a hospital/medical center setting, or supervisory experience of staff responsible for charge master accounts or equivalent combination of education and experience.
-AND-
• Working knowledge of medical terminology.
• Working knowledge of current HCPCS, CPT-4, ICD-9 and/or ICD-10 principles, terminology, and methodology.
• Current knowledge of third-party payer requirements and associated regulatory standards including consecutive account requirements.
• Knowledge of reimbursement methodologies (emphasis on APC and DRG).
• Thorough understanding of current and proposed federal healthcare (Medicare/Medicaid).
• Knowledge of basic accounting principles, procedures, and techniques.
• Knowledge of third-party payer and government fraud/abuse regulations related to billing/reimbursement.
• Demonstrated ability to use computer systems, report writers and applications.
• Proficient in Microsoft Office (Excel, Word, Power Point, Outlook).
• Ability to create detailed Excel spreadsheets and prepares accurate and detailed technical reports.
• Ability to organize and prioritize work to meet timely deadlines.
• Ability to work independently and make decisions in accordance with established policies and procedures.
• Ability to participate in work groups, task forces, committees, and project teams as a liaison with other analysts, administrators, and revenue cycle management.
• Knowledge of electronic and UB-04 and CMS-1500 computerized billing systems and procedures for Hospital and Professional Billing.
• Ability to communicate effectively in oral and written form.
• Ability to compile, analyze, and evaluate data and to create accurate detailed reports from such data.
• Ability to conform to departmental performance standards.
• Ability to establish and maintain effective working relations with superiors, co-workers, other Medical Center employees, patients, third party payers, external agency representatives, and the general public.
NECESSARY SPECIAL QUALIFICATIONS:
Certification or Registration from the American Health Information Management Association (AHIMA) or the American Academy of Professional Coders (AAPC) must be obtained within 6 months in any of the following areas: Certified Coding Specialist (CCS), Certified Coding Specialist-Physician Based (CCS-P),
Registered Health Information Administration (RHIA), Registered Health Information Technician (RHIT), Certified Professional Coder-Hospital (CPC-H), Certified Professional Coder (CPC).
Job Type: Full-time
Pay: $28.
80 - $36.
00 per hour
Benefits:
* 401(k)
* Dental insurance
* Health insurance
* Life insurance
* Paid time off
* Vision insurance
Schedule:
* Day shift
* Monday to Friday
Experience:
* third-party payer reimbursement , or supervisory: 2 years (Required)
Work Location: In person
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