Medical Review Analyst - Diagnostics - Part Time

Hours: M-F Day

Part Time: 20 hours per week

General Summary

Supports clinical areas throughout the System in charge capture, coding accuracy and revenue management. Maintains the department's chargemaster, in conjunction with revenue management, including setting up charges, updating charges and auditing charges against medical documentation. Conducts reviews of departments to optimize reimbursement for the System while ensuring compliance with applicable laws and regulations.

Essential Functions:

• Consults with clinical departments on charge process. Ensures appropriate usage of billing mechanisms and process flow to optimize reimbursement through both coding and charge capture.
• Conducts random reviews comparing medical record documentation to validate charge capture.
• Identifies issues with medical necessity and coding that reduce reimbursement. Works with departments to improve the process.
• Investigates and recommends action steps and works collaboratively with the department to improve processes when control, operational weaknesses and /or compliance issues are found. Performs follow up reviews to ensure action steps were met.
• Ascertains compliance with established policies, plans and procedures as well as external regulations.
• Investigates billing system errors as a result of potentially inappropriate documentation, coding, medical necessity or charging. Follows through with the department to ensure corrective action.
• Investigates payers' denials and institutes appropriate course of action. Develop process improvement if internal review coincides with payer denials to ensure appropriate reimbursement.
• Works with billing and ancillary departments to resolve billing edits and billing inquiries.
• Works in conjunction with Financial Specialist when submitting for appeals for payer denials or requests for reduction in service.
• Interfaces with physicians, managers and staff in departments to ensure quality work product..
• Enters and/or retrieves data from established computer files using knowledge of various computer software applications.

Qualifications

Minimum Education:

• High School Diploma/GED required.
• Associates or Bachelors preferred.

Work Experience:

• 3 years Related experience in billing/coding
• This is a outpatient coding position
• Must have experience in Healthcare
• Prefer experience in imaging coding/billing

Courses and Training:

• Certified Coder Upon Hire Preferred
• CPC-A, CPC, CCS-P, CCA certifications would be a major plus

Knowledge, Skills, and Abilities:

• Excellent written and oral communication skills.
• Basic computer skills.
• Works effectively in a team environment.