Responsible for the review of Inpatient and Outpatient accounts for billing and coding compliance for Patient Financial Services (PFS). He/she monitors for quality and appropriateness of billing, and reviews accounts for appropriate documentation to validate billing information. This employee is also responsible for follow up on outstanding assigned accounts in their billing and follow up work queues. All work is carried out in accordance with PFS approved policies and procedures. The specialist is also responsible for understanding reimbursement aspects of the revenue cycle and will work to ensure the company receives the appropriate reimbursement for charges billed. The auditor is responsible for understanding governmental rules and regulations regarding chargeable verses payable, and the components of a compliance claim.
Qualifications: Education Minimum Level of Education Required: Associate degree in Healthcare, Business Administration, Health Information Management or LPN in lieu of an Associate degree is required.
Licensure/Certification/Registration RHIT, RHIA, or CCS preferred.
Experience Minimum Level of Experience Required: 1 - 3 years of job-related experience Prior job title or occupational experience: Revenue Cycle Experience. Prior specific functional responsibilities: Demonstrated working knowledge of Microsoft Office applications is required. Demonstrated ability to train and educate to all levels of the organization is required. Preferred experience: Current knowledge of Medicare regulations as it relates to charging and reimbursement is highly preferred. Current knowledge of hospital billing is preferred. Knowledge of medical terminology Knowledge of human pathology and diseases and how they relate to diagnosis and DRG assignments