DISTINGUISHING FEATURES OF THE CLASS: The work involves managing the processes related to verifying proper documentation for charge capture activities at the Erie County Medical Center Corporation. The incumbent performs a variety of activities related to revenue integrity including, but not limited to, conducting internal reviews of billing documents, verifying charges are captured and providing related educational materials. The work is performed under the general supervision of the Director of Revenue Capture and Integrity. Supervision is not a function of this position. Does related work as required.
TYPICAL WORK ACTIVITIES:
Compiles regulatory guidelines, records and reports necessary to perform internal reviews;
Obtains and reviews charge sheets to verify capture of appropriate charges for services;
Develops and performs internal reviews to confirm provider documentation verifies those services rendered and billed;
Verifies charges are compliant with applicable laws, regulations and payer guidelines; validates data file transmission of charges;
Develops and publishes internal review findings and recommendations for improving internal controls;
Collaborates with service providers/departments to assist in obtaining charge/reimbursement information for timely completion of charge sheets;
Collaborates with Health Information Management for processing timely entry of appropriate industry coding mechanisms such as current versions of International Classification of Diseases (ICD), Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) for services provided;
Develops and publishes educational materials related to charge capture functions, documentation processes and compliance policies; assists in educating clinical staff;
Assists the Revenue Integrity function in performing related internal reviews related to charging, coding and billing.
FULL PERFORMANCE KNOWLEDGES, SKILLS, ABILITIES AND PERSONAL CHARACTERISTICS: Thorough knowledge of the principles and practices related to charge description master and its related processes such as billing and reimbursement; good knowledge of applicable laws, rules, regulations and accreditation standards as they related to the charge description master and related processes; working knowledge of medical terminology; thorough knowledge of industry coding mechanisms, and their current versions, such as International Classification of Diseases, Current Procedural Terminology and Healthcare Common Procedure Coding System; good knowledge of third-party reimbursement rates and guidelines for processing reimbursements; ability to review posted charges for verifying accuracy and timeliness; ability to summarize findings and prepare related reports; ability to maintain charge description master; ability to develop educational materials and train others on the charge description master and related components; ability to communicate effectively, both orally and in writing; ability to establish and maintain effective working relationships with a diverse constituency; ability to utilize a variety of electronic software applications; sound professional judgment; capable of performing the essential functions of the position with or without reasonable accommodation.
A.) Graduation from a regionally accredited or New York State registered college or university with a Bachelor's Degree and two (2) years of experience in outpatient or healthcare billing, revenue or coding functions; or:
B.) Graduation from a regionally accredited or New York State registered college of university with an Associate's Degree and four (4) years of experience in outpatient or healthcare billing, revenue or coding functions; or:
C.) Possession of a Certified Professional Coder (CPC) Certification as issued by the American Academy of Professional Coders (AAPC) and four (4) years of experience in outpatient or healthcare billing, revenue or coding functions; or:
D.) An equivalent combination of training and experience as defined by the limits of (A), (B) and (C).
NOTE: Verifiable part-time and/or volunteer experience will be pro-rated toward meeting full-time experience requirements.