Major Responsibilities:
- Provide billing and revenue accuracy by conducting charge capture/bill audits (concurrent, prospective and retrospective).
- Perform proactive/concurrent audits for assigned departments or as appropriate to identify areas of billing discrepancies and/or duplicate charges.
- Perform periodic retrospective, charge capture reviews of assigned departments including review of medical record, encounter form, UB-92, and electronic billing tools to identify charging/billing issues.
- Communicate identified audit issues with the department management team. Develop and document improvement process solution with the department management.
- Escalate issues regarding revenue capture or incorrect charging practices when appropriate.
- Escalate issues regarding nursing documentation when appropriate.
- Provide orientation, education training and information to any revenue producing department regarding charge capture, policies, procedures, and underlying processes, ensuring charge accuracy and billing compliance.
- Perform analysis of charges that correlate with documented medical/nursing interventions.
- Verify questionable discrepancies found on bill audits by contacting appropriate internal departments.
- Identify, communicate, and educate inconsistent trends in billing with specific departments.
- Liaison with other hospital departments to solve their internal billing problems on an as-needed basis.
- Identify quality assurance project opportunities.
- Collect, report, and maintain appropriate data in relation to charge capture.
- Develop and implement plans for corrective measures in conjunction with the clinical managers and the Care Connection liaison.
- Participate in ED audit management meeting as required by ED department manager.
- Participate in interdisciplinary teams.
- Review, identify, and process late, missing or lost charges for various hospital departments on an emergency and as needed basis.
- Verify and respond to questions from internal departments regarding billing accuracy.
- Maintain HIPAA security and compliance of medical records for audit use.
- Establish and maintain effective communication with Admitting, Medical Records, Patient Accounts, Nursing Directors/Managers and other areas within the hospital.
Education/Experience Required:
- 3-4 Years previous hospital clinical or coding experience.
- Knowledge of third-party healthcare insurance plans.
Knowledge, Skills & Abilities Required:
- Basic computer skills.
- Excellent communication skills required.
- Familiarity with hospital applications and basic Microsoft Office and Windows applications.
- Certified Coding Associate (CCA) valid and current certification required.
Physical Requirements and Working Conditions:
- Ability to coordinate large projects; work under time pressures and meet deadlines.
- Ability to lift 20 lbs.
- Ability to work independently.
- Skill in understanding and analyzing patient bills and medical records.
- Ability to interact with associates at all levels within the organization.
- Ability to provide superior customer service.
- Ability to investigate, analyze and apply contract language, billing guidelines, medical and reimbursement policies.
- Strong written and oral communication skills and be capable of handling confrontational encounters in a positive manner.
- Must have proven problem-solving abilities and strong analytical skills.
- Travel to local meetings at various sites as necessary.
- Effective organizational skills.
- Skill in understanding charge capture and analyzing patient bills.
- Familiar with reading medical charts.
This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.
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