Responsible for conducting detailed review of hospital itemized bills for identification of billing and coding opportunities for all payor’s claims
Prepare and upload documentation clearly identifying findings
Accurately calculate/verify the value of compliance edits and documentation for claim processing
Monitor multiple reports to track client specific requirements, turnaround time and overall claims progression
Complete claims processing after the Clinical Bill Review and Audit analysis is completed
Adhere to department billing guidelines and documentation
Maintain audit accuracy and productivity standards per the latest requirements
Perform regular audits of lower-level team members for quality assurance, providing detailed feedback and education
Train/Develop new team members utilizing the standard operating procedures and training manual
Assist team members with daily claim inquiries and difficult claim processing
Respond to inquiries from Client Services and Provider Services in a timely manner regarding the reacceptance/revision/reprocessing of claims, claim inquiries, and appeal reviews when necessary
Coordinate/Manage the set up and processing of dual acceptance claims, as well as the creation and accuracy of client facing documentation
Maintain awareness of and ensure adherence to Zelis standards regarding privacy
Requirements
CPC, or other coding certification, strongly preferred
2-4+ years of experience within healthcare industry
Experienced with health/medical insurance and processing of claims
Expert knowledge of facility claims, billing, and reimbursement
Knowledge of ICD-10 and CPT coding guidelines
Proficient in Microsoft Office, including Outlook, Excel, and Word
Business writing and oral communications proficiency
Ability to multitask and strong attention to detail
Diligent research and organizational skills
Demonstrates solid understanding of audit techniques, identification of revenue opportunities and financial negotiation with providers
Proficiency in training techniques aimed at conveying subject matter expertise and scaling staff to maximize savings and revenue
Computer proficiency and technical aptitude with the ability to utilize CMS, EncoderPro, other audit software and tools, MS Office Suite
Thorough knowledge of company and departmental policies and procedures
Benefits
401k plan with employer match
Flexible paid time off
Holidays
Parental leaves
Life and disability insurance
Health benefits including medical, dental, vision, and prescription drug coverage