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BILLING QA COMPLIANCE SPEC

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Administrative/Clerical
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045913 Requisition #
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PFS MEDICARE

FULL TIME/8A-5P/80 HOURS PER PAY

Under the general direction of the SUPV PT FINANCIAL SVS this employee is responsible for the review of Inpatient and Outpatient accounts for billing and coding compliance for Patient Financial Services (PFS). He/she assures that QA monitors for quality and appropriateness of billing and reviews accounts for appropriate documentation to validate billing information on each patient account. This employee is also responsible for following up on outstanding assigned accounts in their billing 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 insure that Premier Health Partners receives the appropriate reimbursement for charges billed via claims. The auditor is responsible for understanding of governmental rules and regulations of what is chargeable vs. payable, and the components of a compliance claim.

 

 

QUALIFICATIONS:

Education:    Associate Degree in Healthcare, Business Administration, Health Information Management or LPN is required.

Licensure:    N/A

Certification: RHIT, RHIA, or CCS preferred

Experience:    Minimum of two years of experience in revenue cycle required.  Demonstrated working knowledge of Microsoft Office applications is required  Demonstrated ability to train and educate to all levels of the organization is required.  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.

Skills/Other:   Strong written and oral communication skills required Ability to research and evaluate information Understanding of how to manage both clinical and financial data elements Strong interpersonal skills necessary to interact with all departments Ability to work and contribute to a team environment Ability to promote a positive work environment. Good interpersonal skills.  Strong organizational skills. Ability to prioritize and coordinate multiple workflows simultaneously.

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