General Description:
• Coordinating and completing line-item charge reviews of patient encounters to ensure accuracy and completeness for insurance and patient billing.
• Verifies and resolves charge discrepancies by utilizing the tools and resources available. Ensures prompt corrections, reimbursements and adjustments as identified.
• Reviewing outpatient and inpatient visits compared to what is billed and communicating with the coding department as well as the other department Mangers if there are discrepancies found.
• Collaborate with the department’s clinical and business colleagues in the development and implementation of educational activities related to charge- capture improvements.
• Works with finance areas such as accounts billable, accounts receivable, registration staff, etc. to continuously improve processes for patient charge identification.
• Assist with review of medical necessity adjustments.
• Assist with monthly claim denial review.
• Assist with contract management claim review to identify underpaid claims or charging issues.
• Maintains patient confidentiality, complies with HIPAA and compliance guidelines established by Artesia General Hospital.
ESSENTIAL VALUES-BASED, LEADERSHIP AND MANAGEMENT COMPETENCIES:
At Artesia General Hospital, our leadership and management practices are grounded in our core values, captured in the acronym S.E.R.V.I.C.E. These values are the foundation of all employee activities and guide us in fulfilling our Mission.
• Servant Leadership – Leading by serving others with compassion and humility.
• Excellence – Striving for the highest quality in all we do.
• Respect – Treating everyone with dignity and kindness.
• Virtuousness – Acting with honesty, integrity, and accountability.
• Innovation – Embracing new ideas to improve care and outcomes.
• Community – Fostering collaboration to meet the needs of those we serve.
• Education – Promoting learning and professional development.
ESSENTIAL FUNCTIONS:
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.
ADDITIONAL RESPONSIBILITIES:
Other duties assigned.
KNOWLEDGE/SKILL/ABILITIES:
Previous patient records review and/or coding experience.
Experience with Thrive/CPSI EHR system.
AGE-RELATED COMPETENCIES: Demonstrates the basic knowledge and skills necessary to identify age-specific patient needs appropriate for this position.
INFORMATION MANAGEMENT: Treats all information and data within the scope of the position with appropriate confidentiality and security.
RISK MANAGEMENT/QUALITY MANAGEMENT/SAFETY: Cooperates fully in all Risk Management, Quality Management, and Safety Activities and Investigations.
ENVIROMENTAL CONDITIONS: Work environment consists of daily patient contact, which may include exposure to blood, or other body fluids.
MINIMUM POSITION QUALIFICATIONS:
• Education – High School Diploma or Equivalent required.
• Minimum of 3 years-experience in healthcare setting (hospital and /or medical office) working with insurance claims processing involving CPT
• Work Experience
Working knowledge of medical terminology and medical procedures.
Detail oriented and self-motivated team player.
Ability to manage daily work independently.
Proficient in Microsoft Word, Excel, Outlook
Skills Required
- High School Diploma or Equivalent
- Minimum of 3 years experience in a healthcare setting working with insurance claims processing involving CPT
- Previous patient records review and/or coding experience
- Working knowledge of medical terminology and medical procedures
- Experience with Thrive/CPSI EHR system
- Proficient in Microsoft Word, Excel, Outlook
- Detail oriented and self-motivated team player
- Ability to manage daily work independently
- Maintains patient confidentiality and complies with HIPAA
What We Do
Artesia General Hospital is a nonprofit general medical and surgical facility providing advanced, compassionate healthcare services including primary care, emergency care, surgery, orthopedics, and behavioral health to communities in Artesia, Carlsbad, and Roswell, NM.
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