Assist in resolving billing edits that are holding patient claims from billing, by reviewing medical records and other applicable documentation. Maintain the integrity of facility Charge Description Master (CDM) and Revenue Integrity Systems Program. Maintain the integrity of all Ancillary Department systems related to billing and revenue. Position will serve as liaison between Administration, the PAS and Ancillary Department Directors regarding revenue and compliance issues. Position will coordinate all retrospective, concurrent, patient complaint and external billing audits. Provide monthly audit results. Develop and coordinate educational in-services to the Business Office staff and Ancillary staff related to charging and billing issues. Review denial trends for documentation or charging issue opportunities. Review high charge stays/procedures for charging accuracy. Ensures web tool (unbilled) items are addressed properly and timely. Serve as primary contact for all charge-related PAS inquiries and issues. DUTIES INCLUDE BUT ARE NOT LIMITED TO
- Analyzing and resolving patient claims being held by billing edits on the Bill 45, Bill 49, DET,CRT, Medical necessity, Correct Coding Initiative, Outpatient Code Editor(OCE), Inpatient Code Editor, Self- Administered and other claims requiring clinical expertise's
- Interact with ancillary departments to obtain additional information needed to properly bill account based on medical record
- Identify charging, coding, or clinical documentation issues and work with ancillary departments to resolve issues and notify appropriate leadership
- Reviews all BHL, Mutual, FCSO, PAS Billing Compliance correspondence and adheres to all guidelines
- Performs assigned audits by researching documentation, analyzing information, and makes recommendations to improve flow of claim and enters all corrections into the systems
- Serves as charge master liaison to include regular reviews of CPT codes, Revenue Codes, review of monthly standard CDM error report and communicating with Ancillary Departments to resolve issues, member of facility FECC Committee; reports charging issues, etc.
- Maintain mandated billing education (i.e. EM Assigner ), attend webcasts and conference calls Perform other related functions as assigned
- Assigns Modifiers and CPT/ HCPCS coding as necessary.
- Reviews all REGS Helpline, FI/MAC, SSC Billing Compliance correspondence and adheres to all guidelines