Periop Revenue Charge Spec, GMH, FT Days

Prisma Health•Greenville, SC

3d•Onsite

About The Position

Ensures complete and accurate revenue integrity charging standards for Perioperative Services for IP/OP surgery centers. Follows compliant charge capture program and billing practices in accordance with Medicare, Medicaid or Third Party payor guidelines.

Requirements

High School diploma or equivalent OR post-high school diploma/highest degree earned
Three (3) years health care revenue cycle
Coding certification from an accredited organization: AAPC, AHIMA or ACMCS or (5) years in a health care facility or physician office practice to include working knowledge of ICD9-CM, CPT/HCPCS,UB-04 revenue codes and /or denials
Five (5) years in Health Information Management with working knowledge of ICD9-CM,CPT/HCPCS.
Team members employed in this job prior to July 1, 2020, are grandfathered under prior educational and experience requirements.
In addition, team members must be certification eligible and will have one year to obtain required certification(s).
CPC to be obtained 2 years after date of hire preferred
Knowledge of office equipment (fax/copier)
Proficient computer skills (word processing, spreadsheets, databases)
Data entry skills
Mathematical skills
Typing skills
Working knowledge of medical terminology, anatomy, physiology. Which can be obtained by on-the job training or through college courses preferred
Familiarity with ICD9-CM, CPT/HCPCS and UB04 codes preferred

Nice To Haves

CPC to be obtained 2 years after date of hire preferred
Working knowledge of medical terminology, anatomy, physiology. Which can be obtained by on-the job training or through college courses preferred
Familiarity with ICD9-CM, CPT/HCPCS and UB04 codes preferred

Responsibilities

Daily audits charge and enters facility fees for Perioperative Services into the Perioperative Information system to include surgery, preop, and recovery.
Analyzes relevant nursing documentation and encounter forms to identify discrepancies in order to accurately capture all revenue.
Enters or credits all implant and supply charges as required into the OPTIFLEX and Demand bill systems assuring accurate and completes charge capture.
Performs daily audits of revenue cycle charge proof reports and Bipas against surgeon's operative note and all other nursing documentation to assure timely, complete and accurate billing for compliance and maximum reimbursement within AR timelines.
Reviews procedures for appropriate CPT codes based on all documentation to assure correct facility fee.
The auditing process includes accessing multiple downstream systems for compliant charge capture and documentation integrity.
Follows established department guidelines and consistently, appropriately and proactively notifies nurses of errors in both documentation and charge capture for correction and clarification to assure both documentation and revenue cycle integrity.
Daily records clinical charge errors discovered through detailed audits processes into department access data base to provide RN Perioperative Business Services documentation necessary in the development of in-services and one on one coaching for the clinical staff.
Monitors, researches and responds to periodic billing problems for Perioperative Services including identifying supply/implants needing item and charge numbers and for CCA and Xclaim inquiries.
Follows up and resolves problems in a timely manner communicating effectively with coworkers, nurses and management staff.
For late charges, follows established protocols.
Assists in annual review of department policies and procedures.
Assumes additional projects as assigned by management.
Performs other duties as assigned.