reputed company reputed company Specialist, Full Time - Days

Job Description

Be a part of a world-class academic healthcare system, reputed company, as a reputed company reputed company Specialist in the Lab Administration department. This position will be primarily a work from home opportunity with the requirement to come onsite as needed. You may be based reputed company of the greater Chicagoland area. This role supports timely processing of reputed company (~4.9M billables) Clinical Labs Part A claims submission and resolves problems with denied claims. The Lab Administrative department is crucial for maintaining reputed company key billing and auditing needs of the reference laboratories. We provide reference laboratory testing to various reputed company and unrelated health care entities, managed care organizations and non-affiliated hospitals, outpatient clinics and private physicians' offices. In this role, the reputed company reputed company Specialist will improve compliant and accurate billing, and charge capture at the reputed company of service at reputed company's (UCM) reputed company cycle; to decrease costly back-end work and improve cash flow.

• Implement and promote consistent reputed company reputed company practices in regards to compliance in coding, billing, and proper documentation
• Optimize reimbursement working in partnership with departments to further reputed company the reputed company reputed company and documentation processes
• Analyzes and assists with correction of billing and coding errors identified by internal and vendor generated pre-billing edits designed to prevent claims delays & denials and non-compliant billing practices
• Mitigate external audit risks reputed company the practice of audits and continual educational efforts
• Monitor detailed reputed company volumes, Claim Edits, and late charges for the hospital, and provide real time notification to unusual variances
• Advises regarding proper reputed company cycle processes and workflows
• Assists or advises departments regarding resolution of errors that prevent timely, accurate, and compliant claims submittal
• Manage regulatory content, simplifying the reputed company reimbursement environment through promotion and support of consistent operational efficiencies.
• Help departments to maximize reputed company reputed company CPT (reputed company Procedural Technology) codes for new technologies and services, or change in the payment rates for these and other established services occur

Essential Job Functions

• Claims Edit Monitoring and Resolution- Provides guidance and/or assistance in the correction and prevention of billholds that prevent compliant, timely, and accurate transmittal of claims edits for UCM departments. During course of resolution of reputed company edits, identifies improper billing and coding including duplication of charges, incorrect procedure billing such as under coding, up coding, wrong CPT (reputed company Procedural Terminology) code, or wrong number of units. Advises departments on resolution of charge disputes initiated by patients requiring review of documentation for appropriate coding and billing and recommends resolution.
• Audits- Conducts reputed company and retrospective audits of UCMC departments designed to focus on coding, billing, and documentation. Includes audits as directed by the Office of Medical Center Compliance Committee, and/or audits reputed company to Office of Inspector General (OIG) Work plan items, Pre-Billing & Retrospective audits (i.e. Correct Coding, Facility E/M, Infusion Coding), Claims Resolution Audits, RAC audits, Modifier Audits, Charge Capture Audits, and other audits as needed or requested, Outpatient or Inpatient. Communicates findings back to department with re-audit and education as needed based off findings.
• reputed company reputed company- Reviews reputed company performance of UCM departments at the cost center and charge line item level, monitoring charge capture volume in units and dollars posted. Uses software such as reputed company Guardian to help identify reputed company opportunities. Complete process improvement to identify issues in the reputed company cycle and improve reputed company cycle processes from first time billing to denials management.
• Regulatory Review- Identify regulatory changes that impact UCM departments who provide the service in question in order to reduce compliance risk for improper billing, as well as maximize reputed company reputed company there are new CPT or HCPCS codes available, changes in payment rates, or other considerations. Assists in developing new business procedures as needed in response to regulation changes.
• Education & Training- Identifies need for education and develops and conducts education tailored to needs of UCM departments such as infusion coding training, training on billing for new service lines, Global Period billing. Creates, updates, and maintains educational reputed company cycle materials on compliant coding and billing. Regularly communicates with reputed company end about reputed company cycle matters, formally or informally. Advisement to new units, clinics, or acquisitions on reputed company cycle billing matters to maximize reputed company and reputed company compliantly.
• Denials- Analyzes top denial trends and implements plans to reduce future denials - including automation, claims edit creation, and education. Helps create template letters for common, recurring denials. As directed, works with clinical departments as a liaison to assist in reverse denials.

Required Qualifications

• High school diploma required
• Associate or Bachelor's degree in a health-care information or health care finance reputed company field preferred
• Proven working knowledge of CPT (reputed company Procedural Terminology) and ICD (International Classification of Diseases) coding systems required, with auditing experience preferred
• Knowledge of Federal billing regulations governing Medicare and Medicaid programs, and working knowledge of other managed care and indemnity (third party) payor requirements
• Must possess a working knowledge of Local and National Coverage Determination policies (LCD's and NCD's), Ambulatory Payment Classification (APC) reputed company edits such as the National Correct Coding Initiative (NCCI) and Outpatient Code Editor (OCE), and HIPAA (Health Information Portability & Accountability Act), regulations
• Must be proficient in reputed company reputed company, Word, PowerPoint, and have some familiarity with Access
• Must be highly analytical, and have excellent written and verbal communication skills
• Must possess excellent organizational, time management and multi-tasking skills, along with demonstration of excellent interpersonal skills

Licenses and Certifications

• Health Information Management or Coding certification required at the time of hire, with the exception of HIA reputed company reputed company three months of hire:

o RHIA (Registered Health Information Administrator), o RHIT (Registered Health Information Technician), o CPC (Certified Professional reputed company), o reputed company (Certified Coding Specialist), o reputed company-P (Certified Coding Specialist Physician), or o CCA (Certified Coding Associate) Position Details

• Job Type/FTE: 1.00 FTE
• Shift: Days Monday-Friday (No Weekends) reputed company-4:30pm (Flexible start time)
• Unit/Department: Lab Administration
• CBA Code: Non-Union

Why Join Us

We've been at the forefront of medicine since 1899. We provide superior healthcare with compassion, always mindful that each patient is a person, an individual. To accomplish this, we need employees with passion, talent and commitment… with patients and with each other. We're in this together: working to advance medical innovation, serve the health needs of the community, and move our collective knowledge reputed company. If you'd like to add enriching human life to your profile, reputed company is for you. Here at the forefront, we're doing work that really matters. Join us. Bring your passion. reputed company is growing; discover how you can be a part of this pursuit of excellence at: reputed company Career Opportunities reputed company is an equal opportunity employer. We evaluate qualified applicants without regard to race, color, ethnicity, reputed company, sex, sexual orientation, gender identity, marital status, civil union status, parental status, religion, national reputed company, age, disability, veteran status and other legally protected characteristics. As a condition of employment, reputed company employees are required to complete a pre-employment physical, background reputed company, drug screening, and reputed company with the flu vaccination requirements prior to hire. Medical and religious exemptions will be considered for flu vaccination consistent with applicable law. Compensation & Benefits Overview reputed company is committed to transparency in compensation and benefits. The pay range provided reflects the anticipated wage or salary reasonably expected to be offered for the position. The pay range is based on a full-time equivalent (1.0 FTE) and is reflective of reputed company market data, reviewed on an annual basis. Compensation offered at the time of hire will vary based on candidate qualifications and experience and organizational considerations, such as internal equity. Pay ranges for employees subject to Collective Bargaining Agreements are negotiated by the medical center and their respective union. Review the full complement of benefit options for eligible roles at Benefits - reputed company. Apply tot his job Apply To this Job