Under limited supervision, conduct charge reconciliation of clinical and financial information. Work with Finance to develop, analyze, report and interpret clinical and financial information from the Clinical Information Systems, Medical Records, and billing system to ensure the accuracy of patient billing and cost reporting. Use the information obtained from the audit process to inform and educate clinical services concerning proper business practices as they relate to patient charge capture and clinical documentation. Assist management with the formation, implementation, and execution of Patient Care Services Business Operations plans. Protects the hospital from loss by ensuring 100% charge capture compliance, front-end registration accuracy, and statistical reporting for the Surgical Service Division.
Essential Job Duties:
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- Plans work for self and with coworkers, including setting goals, prioritizing work and coordinating the execution of work. Determines work priorities and resource allocation across multiple clinical audit activities based on interpretation of data and reports. Uses a systematic process to identify departmental charges.
- Evaluates each patient medical record reviewing specific documents relating to patient treatment and billable charges, identifying services billed versus services rendered. Evaluates patient medical record versus the bill, noting discrepancies in over-, under- and incorrectly billed items, correctly calculates the total dollar and statistical amounts for each discrepancy and bills appropriately.
- Works with Finance to reconcile billing issues. Communicates regularly with AAMC clinical and administrative personnel to obtain further supportive documentation for billed services beyond that which is found in the medical record. Meets with appropriate department personnel to establish methods for obtaining support documentation. To develop working practices with Patient Financial Services, Corporate Compliance, Clinical Reimbursement, Materials Management, and other support services. Gives feedback to other departments.
- Completes and submits audit documentation in a timely fashion.
- Provides leadership and guidance to lower level Surgical Scheduling and CSR staff to ensure maximum productivity and effectiveness in accordance with departmental standards and procedures.
- Assists in education of staff and new-hires relative to charge capture process, communicates negative trends from audits to staff, under the direction of the Business Manager.
- Meets with appropriate department and supervisory personnel to share information obtained during the audit process to assist in the identification of problems that result in a loss of revenue. Manages process for daily reports specific to revenue capture, denied days, on-time starts, cancellation reasons, and other resource oriented productivity measures.
- Review transactions from various reports and prepares summary reports in an accurate and timely fashion for volume, revenue, and cost accounting activity for use by Patient Care Services and Finance. Assist with development, implementation, monitoring of new policies and procedures, which improve AAMC revenue capture.
- Responsible for the accurate and timely completion of written documentation for each department the charge capture process, which should include the process of entering charges, reconciling daily charges, cleaning-up charge rejections and identifying back-up personnel for these processes. Manages process for daily reports specific to revenue capture, denied days, on-time starts, cancellation reasons, and other resource oriented productivity measures.
- Keeps current on clinical practice and protocols that impact the patient claim audit process to include insurance regulations, Medical Center charging practices and clinical therapy updates through communication with Business Manager, appropriate professional publications and conferences.
- A minimum of three or more years of patient billing, surgical supplies, and or registration/collections. A surgical technology or nursing background is a plus. However, a combination of education and experience will be considered, in lieu of professional certification.
- Ability to apply clinical assessment skills to the medical record audit process and extract supportive documentation.
- Effective oral and written communication skills required of working with various hospital departments.
Working Conditions, Equipment, Physical Demands:
There is a reasonable expectation that employees in this position will not be exposed to blood-borne pathogens.
Physical Demands -
Light work. Exerting up to 20 pounds of force occasionally, and/or up to 10 pounds of force frequently, and/or a negligible amount of force constantly to move objects. If the use of arm and/or leg controls requires exertion of forces greater than that for sedentary work and the worker sits most of the time, the job is rated for light work.
The physical demands and work environment that have been described are representative of those an employee encounters while performing the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions in accordance with the Americans with Disabilities Act.
The above job description is an overview of the functions and requirements for this position. This document is not intended to be an exhaustive list encompassing every duty and requirement of this position; your supervisor may assign other duties as deemed necessary.