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Job Summary : This position will be responsible for the entering, reviewing, auditing and maintaining of the hospital charges, charge documentation, and charge capture processes for accuracy and completeness in addition to the ongoing communication of charges. This role is responsible for facilitating proper charge capture and charge audits. Standard billing policies and reimbursement principles, clinical documentation practices, and CPT/HCPCS and ICD-10 CM coding using the hospital's electronic information systems and manual processes.
Job Description Essential Responsibilities a. Knowledge of Medical Necessity guidelines such as LCD's (Local Coverage Determination) and NCD's (National Coverage Determination).
b. Knowledge of APC (Ambulatory Payment Classifications) edits require the review of NCCI (National Correct Coding Initiative), and MUE (Medially Unlikely Edits) requiring addition of payment modifiers to resolve the edit.
c. Ensures accurate and timely charge capture methodologies are in place and executed for the assigned work unit-ensuring they are consistent (in terms of standardization) across pertinent areas/facilities as appropriate; reconciles charges against source documents to ensure that charges have been captured completely and accurately.
d. Identifies, researches, and analyzes billing errors and/or omissions, working with appropriate team members; ensures revisions/corrections are done and followed up with departments.
e. Claims Edit Monitoring and Resolution, provides guidance and/or assistance in the correction and prevention of Claim Edits that prevent compliance, timely, and accurate transmittal of claims.
f. Works with management to identify, trend, and address root causes of denials; helps pinpoint strategies for reducing overpayments.
g. Maintains a thorough understanding of federal and state regulations, as well as specific payer requirements and explanations of benefits, to identify and report charge/billing issues and payer discrepancies.
h. Reviews all Observation accounts and captures infusions and injection charges.
i. Prepares reports and provides departmental summary information to the Revenue Cycle team which is responsible for ensuring that all charges on a system-wide basis are being captured, charged, and reimbursed appropriately and for overall compliance.
j. Assists interdepartmental teams in troubleshooting accounts that are being held due to charging/documentation discrepancies.
k. Facilitates communication with care providers regarding documentation opportunities and/or requirements.
l. Performs related duties as required. Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the associate for this job. Duties, responsibilities and activities may change at any time with or without notice. Education
- High school diploma or equivalent required; Associate degree in coding/billing, or a related discipline is desired.
- Must have three to five years' experience working with hospital charges, coding, or billing.
Licenses or Certifications
- Certification in CCS, CCS-P, COC, CPC, CRCR or specialty coding is desired.
Work Shift : 1st Shift (United States of America)
Scheduled Weekly Hours : 40
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Hendricks Regional Health
Feb 24, 2025