JOB SUMMARY

This position is responsible for identifying, capturing, tracking, reviewing, and resolving held claim edits, claim rejections, and/or denials that result from the claims/billing cycle. This position ensures all resolutions utilized are in accordance with policies, procedures, official coding guidelines/advice, rules and regulations (payer, state, and/or federal). Position requires a working knowledge of ICD-10-CM, ICD-10-PCS, CPT, and HCPCS codes and any appropriate modifiers, various payment methodologies, as well as working knowledge of appropriate, compliant hospital and provider billing and charging practices. This position provides key insights garnered from essential duties and responsibilities to their supervisor and/or manager assisting in proactively identifying areas of opportunity to prevent future edits, rejections, and/or denials of similar nature and improve clean claim rates, prevent revenue leakage, and reduce overall denials. Responsible for fostering and maintaining strong, collaborative relationships with all levels of staff both internally as well as with the facilities, partners, and/or clients we serve including clinical teams and hospital departments.

KNOWLEDGE, SKILLS, ABILITIES

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. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Advanced working knowledge of revenue cycle processes and hospital/medical billing practices, tools, and data to include but not limited to charge description master (CDM), uniform billing (UB) form, remittance advices (RA), claim adjustment codes (CARC), remittance advice remark codes (RARC), and various claim forms (837, 1500s, etc)
Strong attention to detail and enjoys working in a fast paced, progressive, collaborative team based environment.
Advanced personal computing skills, ability to function within multiple systems simultaneously, and problem solve technical issues with various system such as Microsoft office suite, Windows operating system, internet service providers, and various electronic health record and billing applications/systems.
Computer training: Experience in multiple electronic health record and claims billing systems highly desirable. Examples to include, but not limited to Epic, Meditech,HBOC Star; 3M Coding & Reimbursement software; SoftMed Systems; Horizon Patient Folder; Groupwise; DVI Dictation System; External Transcription Agency Systems, Microsoft Office Suite.
Working knowledge of code data sets to include, but not limited to, ICD-10-CM/PCS, CPT, and HCPCS including modifier application..
Working knowledge of NCCI and OCE edits, and CMS LCD/NCDs.
Understanding of reimbursement methodologies to include, but not limited to, IPPS, MS-DRGs, APR-DRGs, OPPS, APC, and HCC.

PERKS

15% night differential
HMO plus free dependents
Group life insurance
PTO Credits
Annual Appraisal

WORKING CONDITION

Work on-site
Morning shift

Edit Resolution Analyst

About Tenet Healthcare