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Revenue Auditor-Burle Business Park (40hrs/week)

Company: Lancaster General Health
Location: Lancaster
Posted on: November 11, 2019

Job Description:

CompanyLancaster General HospitalCost Center2040 Patient Financial ServicesSupervisory OrganizationPatient Financial Services-Revenue IntegrityGradeG13SummaryPOSITION SUMMARY:? Research and analyze data to ensure correct coding and billing. Provide recommendations to improve reimbursement and streamline processes. Assist other areas, both internal and external, in relation to payer audits, insurance appeals, denials and correct billing processes.? Support Patient Financial Services (PFS) in identifying areas in which over/under charging is occurring.ESSENTIAL FUNCTIONS: Qualified individuals must have the ability (with or without reasonable accommodation) to perform the following duties:

  • Perform coding and billing reviews of clinical departments? charges to identify opportunities to improve charge capture through better documentation or utilization of departmental billing systems.? Evaluate documentation to prevent denials and facilitate complete billing.
  • Provide guidance on correct billing processes to clinical departments and facilities.
  • Coordinate chargemaster error findings with chargemaster team.? Assist in researching errors to ensure proper billing and compliance guidelines are followed.
  • Identify trends associated with incorrect pricing, coding, quantity, and/or billing.? Perform research to ensure current policies, applicable coding and insurance guidelines, regulations and laws are being followed.
  • Answer questions from other departments about how to properly charge for services.? Assist in researching new services to ensure proper coding/charging is followed.
  • Develop recommendations to improve reimbursement, to decrease re-work, or to streamline processes.? Assist with developing action plans for revenue integrity improvement projects.
  • Review payer updates and distribute to departments as they apply.
  • Research compliance issues.? Respond to payer compliance audits with next step recommendations and improvements.
  • Act as primary support to the Accounts Receivable team for incoming insurance appeal and audit requests.? Provides guidance regarding resolution to ensure proper payment is received for services provided.SECONDARY FUNCTIONS: The following duties are considered secondary to the primary duties listed above:
    • Coordinate audits of patient accounts with external insurance auditors.? Review findings and correct charges as appropriate in conjunction with medical documentation, payer contracts, payer policies, and billing/coding guidelines.
    • Ensure work queues are maintained and worked within appropriate time frames.? Communicate to departments when time frames are not met.? Provide training when needed.
    • Develop realistic timeline and work plan for all assignments.
    • Assist with other special projects as requested.
    • Other duties as assigned.JOB REQUIREMENTSMINIMUM REQUIRED QUALIFICATIONS:
      • HS diploma or equivalent (GED)
      • Certification as a Certified Coding Specialist (CCS) or Certified Coding Specialist ? Physician (CCS-P) through AHIMA (American Health Information Association), or certified by AAPC (American Association Professional Coders) with certification as a Certified Professional Coder (CPC) ? Hospital Outpatient
      • Formal education in ICD-10-CM/PCS coding, CPT coding, medical terminology, anatomy and physiology
      • Three (3) to five (5) years experience in CPT, ICD-10-CM and ICD-10-PCS, MS-DRG assignment/analysis coding principles/guidelines
      • Knowledge of federal, state and payer specific regulations and policies pertaining to documentation, coding and billing
      • Three (3) to five (5) years experience in the healthcare industry
      • Ability to manage multiple tasks simultaneously, maintain attention to detail and adjust to issues as needed in a dynamic work environment as well as the ability to prioritize and effectively anticipate and respond to issues as they arise
      • Strong written and verbal skills
      • Strong interpersonal skillsPREFERRED QUALIFICATIONS:
        • One (1) to three (3) years of experience working with hospital technical charge capture
        • One (1) to three (3) years of Revenue Cycle Experience
        • One (1) to three (3) years of ICD-10-CM Coding Experience
        • One (1) to three (3) years of CPT-4 Coding Experience
        • Clinical background and knowledge acquired by serving in a CMA, LPN or RN roleCOGNITIVE REQUIREMENTSATTENTION/CONCENTRATION ? The following level of ability is essential for the jobholder to focus on certain aspects of current experience and reject others:
          • The position requires the ability to attend to more than one aspect of a situation simultaneously.? It is highly likely that multiple task demands are going to be required of the individual at the same time.NEW LEARNING AND MEMORY ? The following level of ability is essential for the jobholder to learn and retain material:
            • Job demands are only moderately routine and predictable.? Minor changes may occur which require the individual to be able to understand and carry out detailed but uninvolved instructions.PROBLEM SOLVING, REASONING AND CREATIVE THINKING ? The following level of ability that is essential for the jobholder to think (in order to solve a problem) by combining two or more elements from past experience or imaginative thought:
              • The requirement for autonomous problem solving or creativity of thought in the position is minimal.? Problems encountered tend to involve a few concrete variables in or from standardized situations.? Typically involves adhering to a chart or set procedure.APTITUDES:? The following are essential requirements of the position in relation to job-worker situations.? These items describe how a worker must adapt, adjust, conform or act:Leadership, control and planning: Ability to accept responsibility for leadership, direction, control, planning, negotiating, organizing, directing, supervising, formulating practices, or making final decisions.Variety and change: Ability to perform a variety of duties, often changing from one task to another of a different nature without loss of efficiency or composure involving significant differences in technologies, techniques, procedures, environmental factors, physical demands, or work situations.Communication:? Ability to exchange information with others clearly and concisely; to present ideas, facts and technical information.Interpersonal relations: Ability to maintain relationships that facilitate task accomplishment; to cooperate and resolve conflicts; to recognize needs and be sensitive of others.EQUIPMENT USAGE REQUIREMENTS Equipment/Tools: Computer, Phone, Copier, Printer, Fax, Office SuppliesSoftware: Microsoft Office ProductsPHYSICAL REQUIREMENTSRarely 0-10%; Occasionally 11-35%; Frequently 36-70%; Continuously 71-100%Body Position/Movement:
                • Sit: Frequently
                • Stand: Rarely
                • Walk: Occasionally
                • Bend: Rarely
                • Push: Rarely
                • Pull: Occasionally
                • Kneel/Squat: Rarely
                • Reach: Occasionally
                • Twist: Rarely
                • Balance: Rarely
                • Climb: RarelyLifting: Degree of physical exertion is:Moderate, exerting up to 20 pounds of force occasionally, and/or up to 10 pounds of force frequently, and/or a negligible amount of force constantly to move objects.Sensory Abilities specifically required:
                  • Vision
                  • HearingPHYSICAL ENVIRONMENTWORKING CONDITIONS: Exposure to hazardous conditions/ materials is negligible.???????????????????????????????????Disclaimer: This job description is not intended and should not be construed to be an exhaustive list of all responsibilities, skills, efforts, or working conditions associated with the job.? It is intended to be a reflection of those principal job elements essential for recruitment and selection, for making fair job evaluations, and for establishing performance standards.? The percentages of time spent performing job duties are estimates, and should not be considered absolute.? The incumbent shall perform all other functions and/or be cross-trained as shall be determined at the sole discretion of management, who has the right to amend, modify, or terminate this job in part or in whole.? Incumbent must be able to perform all job functions safely.

Keywords: Lancaster General Health, Lancaster , Revenue Auditor-Burle Business Park (40hrs/week), Accounting, Auditing , Lancaster, Pennsylvania

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