Essential Job functions:
• Utilizes electronic database management systems in the management of charge postings, providing oversight of technical and professional charges generated from ancillary subsystems to verify the accuracy of charges as they compare to the research billing intention/plan.
• Coordinates and completes review of all charges that are incurred on “flagged” accounts daily to ensure that they meet proper classification and payer account eligibility requirements.
• Determines destination account for inpatient, outpatient and physician groupings and directs appropriate evaluated charges to the client account.
• Verifies and resolves charge discrepancies by utilizing the tools and resources available. Ensures prompt corrections/reimbursements/adjustments as identified.
• Under direction of management, collects data regarding charges and prepares reports and develops deliverables summarizing the accuracy of the system.
• Continuously audits electronic charge platform for accuracy and compliance.
• Works with members of organization-wide finance areas such as accounts billable, accounts receivable, registration staff, etc. to continuously improve processes for patient charge identification.
• Analyzes output to determine whether appropriate action was taken and make or request corrective action as required, in accordance with regulatory and institutional policies.
• Collaborates with the department’s clinical and business colleagues in the development and implementation of educational activities related to charge capture improvement projects.
• Maintains operational, GCP, and regulatory compliance at all times, utilizing comprehension of regulations as determined by CMS, CFR, and federal, state, and institutional regulations.
• Generates and monitors budgeting scenarios and continuously evaluates the coding and budgeting process for improvements to support the implementation of action and/or contingency planning.
• Follows patient privacy regulations, maintaining confidentiality in all practice.
• Not applicable for this position
• High School Diploma or Equivalent
• Bachelor's degree in Finance, Accounting, Business/Health Administration or a related field from an accredited program or Bachelor’s Degree in Nursing
One of the following Certifications is Preferred:
• Certified Professional Coder (CPC) or
• Certified Outpatient Coder (COC), formerly CPC-H or,
• Certified Inpatient Coder (CIC) by the American Academy of Procedural Coders or,
• Certified Coding Specialist (CCS), or
• Certified Coding Associate (CCA) by the American Health Information Management Association (AHIMA)
• Minimum of two (2) years of work experience in medical billing; and
• Minimum of three (3) years of work experience in a customer-related service position;
• Working knowledge of medical terminology and medical procedures;
• Previous experience using a personal computer and various software applications, including Microsoft Office Word and Excel, e-mail, etc.
• Detail-oriented and self-motivated team player
• Ability to manage daily work is independently
• Ability to seek direction, advice, guidance from from management, Clinicians and other applicable resources as necessary.
• Ability to meet deadlines in ever changing work environment.
• Previous experience with protocols and/or financial/budgeting for clinical trials;
• Previous patient records review and abstraction experience;
• Previous experience in medical coding; and
• Three (3) years of work experience in a team environment.
Demonstrates a commitment to diversity, equity, and inclusion through continuous development, modeling inclusive behaviors, and proactively managing bias
Periods of high stress and fluctuating workloads may occur.
General office environment.
Physical Demands: Lifting/ Carrying (0-50 lbs.), Push/ Pull (0-50 lbs.), Stoop, Kneel, Squat, Bending
Work Position: Sitting, Walking, Standing
Additional Physical Requirements/ Hazards:
Physical Requirements: Repetitive arm/hand movements, finger dexterity, Acuity - near
Mental/Sensory - Emotional:
Mental/Sensory: Strong recall, Reasoning, Problem solving, Hearing, Speak clearly, Write legibly, Reading, Logical Thinking
Emotional: Fast pace environment
EEO Employer/Disabled/Protected Veteran/41 CFR 60-1.4.