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Responsible for ensuring all charges from the Diagnostic Radiology have been appropriately prepared for posting on the patient''s account. Working closely with the Business Services manager, this individual is accountable for the reconciliation of charge code exceptions on a daily basis. In addition this position is responsible for monitoring and tracking all charges that have been released in the EMR (EPIC) for Billing and Coding. Investigates , reconciles and follows up on all accounts being held in Work queues as Billing errors. .Any variances are identified and reconciled in collaboration with Patient Financial Services , Revenue and Reimbursement and the Hospital Billing Office. Individual works directly with Revenue and Reimbursement for updating , initiating and auditing Revenue codes to ensure the appropriate CPT code has been assigned. . The Revenue and Coding analyst works with Imaging manages and supervisors in reconciling and tracking Billing and Coding Edits and Denials for Imaging procedures ensuring optimal reimbursement. Works collaboratively with the Professional Billing leadership and coding team (s) to ensure the codes match for the Imaging procedure performed and the professional intepretation of the procedure. Understands and follows up on all Imaging procedures that have been assigned Modifiers that may impact reimbursement. Reviews and handles interventional procedures performed within Diagnostic Radiology, IE: Breast Imaging procedures, Spine Injections, aspirations etc. to ensure all codes have been appropriately assigned for optimum reimbursement under the direction of the Lead.
Responsibilities: 1. Reconciles and monitors all charge adjustments. 1.1 1.1 Reviews Error templates from Imaging Managers 1.2 1.2 Follows up in Accountant maintanance to ensure all charges have been correctly identified 1.3 1.3 Adds and/or deletes charges as reviewed with Managers , Radiologists and Revenue and Reimbursement 1.4 1.4 Provides montly report to Business Mgr on volume of errors by modality and reason error occurred as identified by the Lead 2. Identifies lates charges as identified in EPIC. 2.1 2.1 Identifies charges posting late to patient accounts 2.2 2.2 Identifies and documents reason for Late charges 2.3 2.3 Provides monthly feedback to Business Mgr 2.4 2.4 Assists the Lead in identifying and resolving Common themes for late Charges. 3. Ensures Imaging Exam codes in EPIC have appropriate CPT and EAP Codes 3.1 3.1 Reviews requests for Imaging Exam Codes with section Manager 3.2 3.2 Collaborates with the Lead and Revenue and Reimbursement to ensure appropriate EAP code has been assigned 3.3 3.3 Ensures CPT codes are appropriately mapped to the Imaging Exam code being requested 3.4 3.4 Has expanded access in EPIC to ensure duplicate codes are NOT being assigned 3.5 Ensures all insurance pre-authorizations are obtained and follows up to referring physician and/or patient as needed. 3.6 Assist/support/complete other tasks as required and requested by the Manager for Business Services 4. Reviews exam charge edits or denials as identified by billing, coding and/or revenue reimbursement. 4.1 4.1 Provides feedback and expertise to questions related to charge edits, denials or audits as identifed 4.2 4.2 Adjusts Imaging accounts as necessary 4.3 4.3 Uses coding and Reimbursement resources to ensure compliance requirements have been met. 5. Reviews and documents Imaging charges released from EPIC Daily 5.1 5.1 Prepares and runs Revenue and Usage reports from EPIC 5.2 5.2 Documents number of charges released for each Imaging Cost Center 5.3 5.3 Identifies any abnormalies or inconsistencies in charges to Lead 6. Ensures all Work queues have been processed 6.1 6.1 Reviews daily all Billing, Coding, Charge capture work queues 6.2 6.2 Independently works with appropriate individuals to ensure all charges have been released 6.3 6.3 Reports any common themes related to charges in the workqueues to Lead 7. Performs quarterly audits as identified by the Lead 7.1 7.1 Works with Lead and Business Mgr to run quarterly audits 7.2 7.2 Ensures all required data has identified in the audit, IE: order, medical necessity, etc. 7.3 7.3 Provides reports of Quarterly audits in collaboration with the Lead identifying mitigated and unmigated results
Must be a Certified Professional Coder with an Associate degree in Secretarial Science, Business or Healthcare related field required or equal number of years experience in a Healthcare / Third party payer environment.
Minimum 3 to 5 years experience in Medical Coding with an understanding of Third Party payor requirements, Medicare Medical Necessity, LCDs and ABNs.
Excellent telephone communications, interpersonal, coordination and organizational skills. Ability to read computer screens, forms, and other documents and follow written and oral instructions. Moderate keyboarding skills. Ability to work in a fast-paced, changing environment. Ability to respond to unpredictable, changing situations and needs (including clinical crises in the section and otherwise stressful situations and interactions) with professionalism, good judgment and ALWAYS excellent customer relation skills. Prior customer service coordination or clinical experience necessary. Excellent communication and people skills. Individual must be articulate and confident in both oral and written communications . Ability to remain calm and professional in high stress situations.
Incumbent is held accountable for accuracy and timeliness of own work as it relates to timely release of Radiology charges, appropriate CPT code identification and Chargemaster and EMR updates. Sets priorities and maintains knowledge of all Diagnostic Radiology procedures, protocols, and requirements related to Charge Capture. Ability to work in a fast paced, changing environment. Is held accountable for department reimbursements related to correct coding initiatives.
Exercises independent judgment and tact in dealing with all customers, (patients, visitors, callers, managers, physicians and other Department and Hospital personnel). Utilizes knowledge of Medical Coding and understanding of 3rd party payor requirements to ensure billing compliance. Requires ongoing continuing educations related to coding and reimbursement associated with medical necessity and appropriateness of exam being performed. Must be confident with attention to detail and professionalism when interacting with physicians, Managers, Directors and Third party payers. Must be mindful and understand CMS requirements to HCPC, CPT, ICD 9 and soon ICD 10 requirements. Also must be fully versed with experience on appropriate use of modifiers that will directly revenue and reimbursement.
Primarily sedentary work sitting within typical office setting without exposure to adverse environmental conditions. Requires occasional ability to lift, push and pull objects such as files and office supplies up to 30 pounds and/or continuously up to 10 pounds; and occasional moving about on foot to accomplish tasks, walking long distances or moving from one work site to another. Continuous use of telephones requiring ability to hear and speak to convey detailed or important instructions accurately, loudly or quickly; and continuous use of computer and other office equipment requiring fingering and excellent keyboarding skills.