Charge Review Specialist III - Remote

Description

JOB SUMMARY

This job is responsible for ensuring that all appropriate billing charges for complex service lines are being captured, documented, charged and reimbursed for the assigned department in accordance with policies and procedures, and applicable regulatory standards and requirements. Position requires a working knowledge of CPT codes. Focus on work unit and/or service-line reconciliation processes

ESSENTIAL DUTIES AND RESPONSIBILITIES

Include the following. Others may be assigned.

• Ensures accurate and timely charge-capture and abstracting methodologies are in place and followed for the assigned work unit or service line, and that 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; monitors compliance with internal standards and procedures, and report non- compliance issues to proper authority.
• Identify billing errors and/or omissions, working with appropriate staff/team members; ensures that revisions/corrections are forwarded and incorporated in processing systems in a timely manner. In-depth research and analysis may be required. Strong working knowledge of CPT codes is essential.
• Provides training for staff engaged in charge- capture/reconciliation activities to ensure procedures are understood and that charges booked are timely, appropriate, accurate, complete and properly documented.
• 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 is being captured, charged and reimbursed appropriately and for overall compliance. Communicates and resolves coding/charge capture delays and challenges for all departments applicable (missing documentation, missing supplies, charging errors, etc.).
• Provide subject matter expertise and proficiency to implement changes including system and process improvements that prevent charging errors omissions as well as collaborating in the upkeep & maintenance of clinical charging systems in specified modalities (including but not limited to cardiac catheterization, electrophysiology, interventional radiology, diagnostic imaging, Period/Surgery, ED, injections and infusions and/or labor and delivery

• Job description is not an all-inclusive list of duties and may be subject to change with or without notice. Staff are expected to perform other duties as assigned.Other Duties as assigned including but not limited to edit/holds, coordination with CDM team/system, client & peer education and training
• Meets or exceeds quality reviews with accuracy of 95%
• Meets or exceeds productivity standards as outlined by department’s policies

KNOWLEDGE, SKILLS, ABILITIES

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Knowledge of anatomy, physiology, pharmacology, and medical terminology as well as medical abbreviations and health care nomenclature and systems
• Knowledge of the accepted principles, practices and tools relating to general healthcare billing, cost accounting and reimbursement.
• Knowledge of policies, standards and methodologies pertaining to charge capture and reconciliation, reporting, documentation and general compliance.
• Knowledge of the content and application of published health information management coding conventions, e.g., as referenced in "Coding Clinics" and/or other nationally recognized coding guidelines.
• Ability to recognize, research, and correct charging/documentation discrepancies.
• Knowledge of the standards and regulatory requirements applicable to matters within designated scope of authority, including medical/legal issues.
• Ability to use office equipment and automated systems/applications/software at an acceptable level of proficiency.
• The ability to establish and maintain effective working relationships as required by the duties of the position.

Conifer requires its candidates, as applicable and as permitted by law, to obtain and provide confirmation of all required vaccinations and screenings prior to the start of employment. This may include, but is not limited to, the COVID-19 vaccination, influenza vaccination, and/or any future required vaccines and screenings.

EDUCATION / EXPERIENCE

Include minimum education, technical training, and/or experience required to perform the job.

Required:

• High School graduate or equivalent required
• Certified Coder (AAPC or AHIMA Credential) with a minimum of 3 years’ recent coding experience in a healthcare environment with significant and constant exposure to healthcare charging/coding
• Proficient in CPT/HCPCS code assignments per coding guidelines and any applicable regulation

Preferred:

• College degree
• EPIC experience
• Previous chart audit experience
• Chargemaster (CDM) experience
• National Correct Coding Initiative (NCCI) edit experience

PHYSICAL DEMANDS

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Must be able to work in a sitting position, use computer and answer telephone
• Visual acuity to read information from computer screens, forms and other printed materials and information.
• Able to speak (enunciate) clearly in conversation and general communication.
• Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions.
• Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting.

WORK ENVIRONMENT

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Office Work Environment

As a part of the Tenet and Catholic Health Initiatives family, Conifer Health brings 30 years of healthcare industry expertise to clients in more than 135 local regions nationwide. We help our clients strengthen their financial and clinical performance, serve their communities and succeed at the business of healthcare. Conifer Health helps organizations transition from volume to value-based care, enhance the consumer and patient healthcare experience and improve quality, cost and access to healthcare. Are you ready to be part of our solutions? Welcome to the company that gives you the resources and incentives to redefine healthcare services, with a competitive benefits package and leadership to take your career to the next step!

Compensation and Benefit Information

Compensation

• Pay: $27.30-$40.95 per hour. Compensation depends on location, qualifications, and experience.
• Position may be eligible for a signing bonus for qualified new hires, subject to employment status.
• Conifer observed holidays receive time and a half.

Benefits

Conifer offers the following benefits, subject to employment status:

• Medical, dental, vision, disability, and life insurance
• Paid time off (vacation & sick leave) – min of 12 days per year, accrue at a rate of approximately 1.84 hours per 40 hours worked.
• 401k with up to 6% employer match
• 10 paid holidays per year
• Health savings accounts, healthcare & dependent flexible spending accounts
• Employee Assistance program, Employee discount program
• Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder & childcare, AD&D, auto & home insurance.
• For Colorado employees, Conifer offers paid leave in accordance with Colorado’s Healthy Families and Workplaces Act.