Billing Integrity Analyst

St. Elizabeth Healthcare•Remote Kentucky, KY

9d•Onsite

About The Position

This position performs daily quality control (review, correction, and feedback), ensuring the timeliness, accuracy and compliance of revenue capture for St. Elizabeth Healthcare charges. As well as charge capture audits on a concurrent and retrospective basis, to reconstruct the itemized billing statement/UB04 from the source documentation. Charges not captured and charges that may have erroneously been captured are identified. This position includes charge development, lost charge analysis, account audits/analysis, Charge Description Master support and maintenance, timely filing, and unbilled accounts receivable root cause analysis resulting in reimbursement optimization. This position will also perform defensive audits as necessary. Demonstrate respect, dignity, kindness and empathy in each encounter with all patients, families, visitors and other employees regardless of cultural background.

Requirements

High School Diploma
Knowledge of how services provided by the hospital are billed
Experience with EPIC, MIDAS
Ability to identify from the chart the pertinent documentation to substantiate billed and unbilled charges.
Previous utilization review and knowledge of applicable state, federal, and third-party regulations and standards
Excellent interpersonal skills for interfacing with department heads, third party auditors, hospital personnel and patients.
PC skills using multiple systems/applications including EPIC
Ability to perform autonomously, utilizing critical thinking skills
3 years medical audit, coding or healthcare related field experience

Responsibilities

Assigns appropriate billing/coding (modifiers) as related to defense audits, charge capture, ABNs, billing edits and completes all work queues.
Follows accounts to resolution.
Identifies trends and areas of opportunity strategies to reduce edits and improve compliance.
Provides comprehensive reporting and analysis.
Understands Medicare, Medicaid and managed care contract payment guidelines (including carve outs) to notice correct reimbursement.
Reviews and follows-up on edits, denials, appeals, and lost claims.
Effectively communicates edit/audit/denial findings to the various departments throughout the organization.
Participates in policy / procedure / work plan designs as new audits /edits are uncovered.
Adheres to the National Care Billing Audit Guidelines and St. Elizabeth’s corporate compliance program while performing all duties detailed.
Assists with new charge development and CDM support and maintenance.
Performs other duties as assigned.