Performs analysis of patient clinical and billing data to identify documentation, coding and charging opportunities. Works pre-bill edits and collaborates with intra-departmental team members to identify root cause. Assists with compliance, education, accuracy in charge capture and improvement in the revenue cycle processes as identified through revenue cycle audits and root cause analysis. Works closely with clinical areas to effectively document services performed and understand relationship of documentation, medical necessity, coding and charging for all services provided. Completes assigned reports timely and accurately. May be required to travel between locations within the Region as this is a Regional position in the hospital setting.
As a mission-driven innovative health organization, we will become the national leader in improving the health of our communities and each person we serve. By demonstrating reverence, commitment to those who are poor, justice, stewardship, and integrity, our organization will continue to provide better health, better care, at lower costs.
*MINIMUM QUALIFICATIONS *
- Must possess a demonstrated knowledge of clinical processes, charge master maintenance, clinical coding (CPT, ICD-10, revenue codes and modifiers), charging processes and audits, and clinical billing as normally obtained through a Bachelor's degree in Healthcare or Business Administration, Finance, Accounting, Nursing, or a related field, or an equivalent combination of years of education and experience.
- Three (3) or more years of experience in billing, charge documentation, charge audit or charge capture activities, or other functions related to revenue cycle activities.
- Proficiency with MS Excel, Access, Business Objects highly desired, and strong level of competency with Word and PowerPoint.
- Working knowledge of third party payer rules and requirements, computer operations and electronic interfaces related to charge documentation, capture and billing is required. Licensure / Certification: RHIA, RHIT, CCS, CPC/COC or other coding credentials strongly preferred. CDC (Healthcare Compliance Certification) preferred.
- Must possess a demonstrated knowledge of clinical processes; charge master maintenance, clinical coding (CPT, HCPCS, ICD-9/10, revenue codes and modifiers), charging processes and audits, and clinical billing.
- Knowledge of Ambulatory Payment Classification (APC), and Outpatient Prospective Payment System (OPPS) reimbursement structures and prebill edits including Outpatient Coding Edits (OCE)/Correct Coding Initiative (CCI) edits and Discharged Note Final Billed (DNFB).
- Must be able to work in an environment that may be stressful with a variety of individuals having diverse personalities and work styles.
- Exceptional organizational skills and ability to prioritize and manage multiple functions and responsibilities simultaneously.
- Possess strong analytical, interpersonal, written and verbal communication skills.
- Knowledge of charge capture, reconciliation, error management operations and overall revenue cycle operations required.
Job Number: 00171968
Location: Grand Rapids, MI
Facility: MHWMI - Main Hospital
Employment Type: Full time