BILLING QA COMPLIANCE SPEC

Premier Health • Moraine, OH

4d

About The Position

Under the general direction of the Supervisor Patient Financial Services, the Billing QA Compliance Spec reviews inpatient and outpatient accounts for billing and coding compliance within Patient Financial Services (PFS). The specialist monitors billing quality and reviews account documentation to validate billing information. They follow up on outstanding assigned accounts in billing and follow-up work queues, following PFS-approved policies and procedures.

The role requires understanding reimbursement aspects of the revenue cycle and helping ensure Premier Health receives appropriate reimbursement for billed charges. The specialist must understand governmental rules and regulations concerning chargeable versus payable items and the components of a compliant claim. As applicable to job duties, the specialist monitors timely billing and follow-up of clinical trial accounts as part of work-queue audit reviews.

Requirements

• High school diploma or GED with 3–5 years of experience, or an associate degree in Healthcare, Business Administration, or Health Information Management.
• Three to five years of job-related experience; revenue cycle experience is identified as prior occupational experience.
• Working knowledge of Microsoft Office applications, including Word and Excel.
• Ability to train and educate people at all levels of the organization.
• Strong written and oral communication skills.
• Ability to research and evaluate information.
• Understanding of how to manage clinical and financial data elements.
• Strong interpersonal skills to interact with all departments and contribute to a team environment.
• Ability to promote a positive work environment.
• Strong organizational skills and ability to prioritize and coordinate multiple workflows simultaneously.
• Attention to detail and ability to review work for accuracy and completeness.
• Basic knowledge of accounting principles, including debits and credits.
• Basic math skills, including percentages.
• Ability to manage time effectively and remain composed under pressure.

Nice To Haves

• Current knowledge of Medicare regulations related to charging and reimbursement.
• Current knowledge of hospital billing and follow-up.
• Knowledge of medical terminology, human pathology, diseases, and their relationship to diagnoses and DRG assignments.
• Medical terminology knowledge.

Responsibilities

• Review inpatient and outpatient accounts for billing and coding compliance.
• Monitor billing quality and review documentation to validate billing information.
• Follow up on outstanding assigned accounts in billing and follow-up work queues.
• Work in accordance with PFS-approved policies and procedures.
• Apply understanding of revenue-cycle reimbursement to help ensure appropriate reimbursement for billed charges.
• Understand governmental rules and regulations regarding chargeable versus payable items and the components of a compliance claim.
• As applicable, monitor timely billing and follow-up of clinical trial accounts through work-queue audit reviews.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED