Improve compliant and accurate billing and charge capture at the point of service in the University of Chicago Physicianâ™s Group (UCPG) revenue cycle to decrease costly back-end work and improve cash flow. Implement and promote consistent revenue integrity practices in regards to compliance in coding, billing, and proper documentation. Optimize reimbursement working in partnership with departments to further develop the revenue stream and documentation processes. Analyzes and assists with correction of billing and coding errors, and provide real time notification to unusual variances. Advises regarding proper revenue cycle processes and workflows. Assists or advises departments regarding resolution of errors that prevent timely, accurate, and compliant claims submittal. Help departments to maximize revenue when CPT (Current Procedural Technology) codes for new technologies and services.
Review coding accuracy, documentation, application of modifiers, diagnosis codes as appropriate for all Care Network and CAC Ambulatory charge review WQâ™s
Review NCCI (National Correct Coding Initiative) and MUE (Medically Unlikely Edits) requiring addition of payment modifiers to resolve the edit.
Identify charging, coding, or clinical documentation issues and work with appropriate leadership and ancillary departments, etc. regarding charging and clinical documentation issues.
Provides guidance and/or assistance in the correction and prevention of charges that prevent compliant, timely, and accurate claims.
Review clinical documentation against payor specific Medical Necessity guidelines such as LCDs (Local Coverage Determinations) and NCDs (National Coverage Determinations) with the review and coding of conditions and symptoms found in the medical record and via physician query to resolve the edit.
Evaluates and analyzes data to ensure all physician billing claims denied inappropriately by payors are identified, appealed, and reversed.
Works closely with department leadership and coders to review and obtain Letters of Medical Necessity required to facilitate the denial appeals process.
Proactively works with cross-functional teams within UCPG to develop procedures to reduce the number of denials received through reporting and education of denial trends.
Categorizes denials based on root cause findings and communicates information to applicable management and associated teams
Serves as a resource when necessary for coding, billing, and reimbursement issues.
Continuously reviews applicable regulations, updates, and maintains current understanding.
Performs special audit requests for denials and assists in the writing of appeal letters.
Ability to present information in ono-on-one and group settings
Ability to communicate information in a professional and confident manner
Demonstrated ability in critical thinking, self-initiative, and self direction
Understanding of physiology, medical terminology, and disease process is required
Must understand and be able to apply the following regulations: CMS Evaluation and Management Documentation Guidelines, CMS Teaching Physician Guidelines ,CMS Correct Coding Initiative and Third Party Payer Reimbursement Policies and Procedures.
Ability to interpret documents such as, but not limited to encounter forms, medical records, physician documentation, lab reports, dictated reports, operating instructions, and policy/procedure manuals.
Ability to write correspondence proficiently.
Ability to interact with all levels of health care team professionally.
Ability to work independently.
Ability to meet deadlines and goals.
Ability to demonstrate critical thinking by summarizing issues researched and presenting issues and their solutions to management.
Ability to use research skills to gain info on complex coding/billing issues.
Education, Experience or Certifications:
Two year college degree Health Information Management or equivalent work experience required.
Certified Professional Coder (AAPC) or Certified Coding Specialist-Physician based (AHIMA) required.
Must have strong E/M coding experience.
Four to five years demonstrated knowledge of coding.
Two years previous experience in medical record chart documentation review.
Two yearsâ™ experience in group education with provider audiences.
One year working with Epic PB Resolute/EpicCare.
Technical Knowledge or Skill:
Must be proficient in Microsoft Excel, Word, Powerpoint.
Strong analytical, problem solving, interpersonal, verbal/written communication, organizational, project management and team development skills are necessary as is knowledge of health information systems and database technology.
Must be able to create coding-based curriculum and training materials, deliver effective oral presentations and prepare concise written reports for a variety of audiences and possess basic computer skills.
Reference Contact Information
NOTE: When applying, all required documents MUST be uploaded under the Resume/CV section of the application.
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