Job Description

Engage with us for your next career opportunity. Right Here.

Job Type:

Regular

Scheduled Hours:

40

Job Summary:

This position performs review, correction, and feedback on Professional Services departmental charges. In concert with SEH Billing, HIM and Denials, works to assure the completeness, timeliness and accuracy of Professional Services claims. Performs prospective and retrospective audits. Utilizes available technology to detect coding and billing errors. Works with clinical managers to assure accurate and complete chargemasters via annual review.




Demonstrates respect, dignity, kindness and empathy in each encounter with all patients, families, visitors and other employees regardless of cultural background.

:

Conducts reimbursement audits consistent with National Care Billing Audit Guidelines and St. Elizabeths Corporate Compliance Program to determine charge accuracy and deficiencies. Identifies reimbursement gaps and updates charges to include appropriate billing/coding (modifiers) as related to defense audits, charge capture, ABNs, billing edits using manual resources and automated workqueues. Identifies trends and areas of opportunity strategies to reduce charge edits, support appropriate charge capture, reduce third-party payer denials, and improve compliance. Provides Assists in developing comprehensive reporting and analysis. Understands Medicare, Medicaid and commercial/managed care contract payment guidelines (including carve-outs) to support and flag correct reimbursement.

Assists in the

reviews and follows-up on edits, denials, appeals, and lost claims. Effectively communicates edit/audit/denial findings to the various departments throughout the organization in order to prevent issues or missed opportunities. Provides training and education to staff regarding trends of CMS, NCCI, and AMA changes. Participates in policy/procedure/work plan designs as new audits/edits are uncovered. Adheres to the National Care Billing Audit Guidelines and St. Elizabeths Corporate Compliance Program while performing all duties detailed. Assists with new charge development and CDM support and maintenance. Performs other duties as assigned.

Education, Credentials, Licenses:

Associate degree in a healthcare or similar field Certified coder

Specialized Knowledge:

Knowledge of the operational process of charge capture in clinical units EPIC, HIM/EHR software Excellent interpersonal skills for interfacing with department heads, third party auditors, hospital personnel and patients

Kind and Length of Experience:

2 years of medical audit, coding, or healthcare related field experience

FLSA Status:

Exempt
Right Career. Right Here. If you're looking for the right careers in healthcare, the right place to be is at St. Elizabeth. Join us, and you'll take pride in the level of care we offer our community.