Primarily responsible for reviewing and accurately billing complex, unresolved outpatient medical claims (i.e. surgery, interventional radiology, interventional cardiology, and surgical radiology procedures, etc.) for all UH hospitals. Also responsible for edits for specifically identified inpatient claims.
*Monitors status of all claims being reviewed within the department and ensures held claims are being processed timely and accurately.
*Partners with UH RCM Follow-up and Customer Service staff to analyze, review and resolve complex payer rejected claims.
*Maintains in-depth knowledge of regulations and policies affecting the medical billing industry. Reviews and communicates regulatory changes to the appropriate UH entities in conjunction with the Revenue Integrity Systems Analysts.
* Responsible for initiating process improvements with UH departments related to medical necessity and CCI requirements.
* Identifies incorrect billing trends; notifies management of issues and provides staff education and training as needed.
*Liaison with Health Information Management regarding coding questions and problems.
*Reviews and analyzes inpatient claims.
*Performs billing and collection of specialty claims (i.e. Hemophilia, 1500 Urgent Care billing, Bariatric Surgery, Diaphragm Pacing claims, and Percutaneous Carotid Stenting claims). These claims require review and analysis to assure that they are submitted with the correct and necessary information.
*Serves as a resource to co-workers for questions, and provides assistance with problem resolution.
*Answers and researches coding questions that may be posed by different departments to assure that claims billed are reported correctly and are compliant.
*Performs other related duties as assigned.
*This role may encounter Protected Health Information (PHI) as part of regular responsibilities. UH employees must abide by all requirements to safely and securely maintain PHI for our patients. Annual training, the UH Code of Conduct and UH policies and procedures are in place to address appropriate use of PHI in the workplace.
Experience & Knowledge:
Five plus years' experience with hospital revenue accounting, billing, reimbursement and/or patient accounting required.
Extensive knowledge of CPT, HCPCS, and ICD-9 and ICD-10 diagnosis coding, and medical terminology required.
Must be detail-oriented and organized, with good analytical and problem solving ability.
Notable client service, communication, presentation and relationship building skills required.
Ability to function independently and as a team player in a fast-paced environment required.
Must have strong written and verbal communication skills.
Demonstratedability to use PCs, Microsoft Office suite, and general office equipment (i.e. Printers, copy machine, FAX machine, etc.) required.
Quadax and/or HDS experience preferred.
High School diploma or equivalent required.
Associate's degree preferred.
Credentials, Licensure or Certification:
CPAM, CCS or RHIT strongly preferred.
Equal Opportunity Employer - minorities/females/veterans/individuals with disabilities/sexual orientation/gender identity.
Location/Region: Cleveland, OH (US - 44101)