Charge Reconciliation Analyst

Job DetailsPosition Type: Full TimeEducation Level: High School Diploma / GEDSalary Range: $23.00 - $36.33 HourlyTravel Percentage: NoneJob Shift: DayJob Category: Business OfficeJob Summary: General Description: This is a dual department position performing services in both Patient Financial Services and Health Information Management Coding with shared work responsibilities. Essential Values-Based, Leadership and Management Competencies: At Artesia General Hospital, our leadership and management practices are grounded in our core values, captured in the acronym S.E.R.V.I.C.E. These values are the foundation of all employee activities and guide us in fulfilling our Mission. Servant Leadership – Leading by serving others with compassion and humility. Excellence – Striving for the highest quality in all we do. Respect – Treating everyone with dignity and kindness. Virtuousness – Acting with honesty, integrity, and accountability. Innovation – Embracing new ideas to improve care and outcomes. Community – Fostering collaboration to meet the needs of those we serve. Education – Promoting learning and professional development.   ESSENTIAL FUNCTIONS: 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. Coordinating and completing line-item charge reviews of patient encounters to ensure accuracy and completeness for insurance and patient billing. Verifies and resolves charge discrepancies by utilizing the tools and resources available. Ensures prompt corrections, reimbursements and adjustments as identified. Reviewing outpatient and inpatient visits compared to what is billed and communicating with the coding department as well as the other department Mangers if there are discrepancies found. Collaborate with the department’s clinical and business colleagues in the development and implementation of educational activities related to charge- capture improvements. Works with finance areas such as accounts billable, accounts receivable, registration staff, etc. to continuously improve processes for patient charge identification. Assist with monthly claim denial review. Work coding claim edits. Review CCI edits and documentation to determine if modifiers are appropriate Review claims edits for medical necessity.  Review documentation for supporting diagnosis codes. Review claim edits for MUE’s (Medically Unlikely Edits) and determine appropriate correction. Review claim edits to determine if claim should be sent to different department queues. Compile user friendly Denials Management Report from Qlik Denials Management Report to aid in determining true, preventable denials that we could be placed into an action plan to decrease such denials. Build and maintain a shared folder of payer policies for coding and medical necessity to aid in decreasing claim edits and denials based on these policies ICD-10 and CPT/HCPCS coding. Review pending clinic accounts for complete documentation, signatures, etc. Any other assigned duties. KNOWLEDGE/SKILL/ABILITIES: Previous patient billing and patient record review with preferred coding experience. AGE-RELATED COMPETENCIES: Demonstrates the basic knowledge and skills necessary to identify age-specific patient needs appropriate for this position. Information Management: Treats all information and data within the scope of the position while maintaining patient confidentiality and security. Complies with HIPAA and compliance guidelines established by Artesia General Hospital. Risk Management/Quality Management/Safety: Cooperates fully in all Risk Management, Quality Management, and Safety Activities and Investigations.   Qualifications Education – High School Diploma Work Experience – Billing & Coding knowledge preferred. ENVIROMENTAL CONDITIONS: Remote home conditions.