Major Responsibilities:

Provide billing and revenue accuracy by conducting charge capture/bill audits (concurrent, prospective and retrospective).    4)Escalate issues regarding revenue capture or incorrect charging practices when appropriate    5)Escalate issues regarding nursing documentation when appropriate    1)Perform proactive/concurrent audits for assigned departments or as appropriate to identify areas of billing discrepancies and/or duplicate charges    2)Perform periodic retrospective, charge capture reviews of assigned departments including review of medical record, encounter form, UB-92, and electronic billing tools to identify charging/billing issues    3)Communicate identified audit issues with the department management team. Develop and document improvement process solution with the department managementProvide orientation, education training and information to any revenue producing department regarding charge capture, policies, procedures, and underlying processes, ensuring charge accuracy and billing compliance.    3)Identify, communicate, and educate inconsistent trends in billing with specific departments.    1)Perform analysis of charges that correlate with documented medical/nursing interventions    2)Verify questionable discrepancies found on bill audits by contacting appropriate internal departmentsLiaison with other hospital departments to solve their internal billing problems on an as-needed basis.    1)Identifies quality assurance project opportunities.    2)Collects, reports, and maintains appropriate data in relation to charge capture.    3)Develops and implements plans for corrective measures in conjunction with the clinical Manages and the Care Connection liasion    4)Participates in ED audit management meeting as required by ED department manager    5)Participates in interdisciplinary teams    6)Review, identify, and process late, missing or lost charges for various hospital departments on an emergency and as needed basis    7)Verify and respond to questions from internal departments regarding billing accuracy    8)Maintain HIPPA security and compliance of medical records for audit use    9)Establish and maintain effective communication with Admitting, Medical Records, Patient Accounts, Nursing Directors/Managers and other areas within the hosptial.

Education/Experience Required:

–3-4 Years previous hospital clinical or coding experience. –Knowledge of third-party healthcare insurance plans

Knowledge, Skills & Abilities Required:

Basic computer skills. –Excellent communication skills required. –Familiarity with hospital applications and basic Microsoft Office and Windows applications–Certified Coding Associate (CCA) valid and current certification required

Physicial Requirements and Working Conditions:

–Ability to coordinate large projects; work under time pressures and meet deadlines. --Ability to lift 20# –Ability to work independently. –Skill understanding and analyzing patient bills and medical records. –Ability to interact with associates at all levels within the organization. Ability to provide superior customer service. –Ability to investigate, analyze and apply contract language, billing guidelines, medical and reimbursement policies. –Strong written, and oral communication skills and be capable of handling confrontational encounters in a positive manner. –Must have proven problem-solving abilities and strong analytical skills –Travel to local meetings at various sites as necessary –Ability to work under time pressure and meet deadlines. –Ability to communicate effectively and work independently. –Effective organizational skills. –Skill in understanding charge capture and analyzing patient bills. –Familiar with reading medical chart.

This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.