CHARGE ENTRY ANALYST

Company: Mercyhealth
Location: Janesville
Posted on: March 15, 2020

Job Description:

JOB SUMMARY Responsible for ensuring that all Emergency Department billable medical services and supplies are accurately documented and charged based on payer regulations and department policies. Responsible for reviewing charges that are loaded thru an interface, to ensure they are accurate and timely. Coordinate efforts with the certified coders to prevent errors and contact physician offices for resolution.ESSENTIAL DUTIES AND RESPONSIBILITIES Enters facility related ED charges, including facility E&M and injection and infusion charges within the guidelines set by the organization. Review physician and facility documentation to identify missing charges. Interact directly with physicians and other providers to resolve coding or documentation questions prior to charge entry. Work with the clinical staff on capturing late charges that require charge entry into the billing system and coordinate efforts to resolve any further issues. Responsible for reviewing and correcting errors/edits related to ED charges. Responsible for working identified work queues in the billing system and EMR. When charge errors are identified, notify appropriate departments and provide education, as needed. Reviews reports from the EMR and identifies and resolves discrepancies. Conducts reviews on individual patient accounts or categories of charges as part of routine compliance audits or as requested by internal department. Reports findings to requestor and conducts any required follow-up. Makes episode data and charge related corrections in the electronic billing system to ensure accuracy of charges and billing. May assist with researching coding inquiries with respect to third party insurance claim denials. Maintain current knowledge of applicable insurance coding and regulations, other legal reporting /compliance requirements, software functionality, and clinic policies and procedures in a rapidly changing environment and maintains related reference material. Demonstrates a basic understanding of CPT, ICD-10 and HCPCS guidelines, including linking of codes, correct use of modifiers, and global surgery rules.CULTURE OF EXCELLENCE BEHAVIOR EXPECTATIONSTo perform the job successfully, an individual should demonstrate the following behavior expectations:Quality - Follows policies and procedures; adapts to and manages changes in the environment; Demonstrates accuracy and thoroughness giving attention to details; Looks for ways to improve and promote quality; Applies feedback to improve performance; Manages time and prioritizes effectively to achieve organizational goals.Service - Responds promptly to requests for service and assistance; Follows the Mercyhealth Critical Moments of service; Meets commitments; Abides by MH confidentiality and security agreement; Shows respect and sensitivity for cultural differences; and effectively communicates information to partners; Thinks system wide regarding processes and functions.Partnering - Shows commitment to the Mission of Mercyhealth and Culture of Excellence through all words and actions; Exhibits objectivity and openness to other's views; Demonstrates a high level of participation and engagement in day-to-day work; Gives and welcomes feedback; Generates suggestions for improving work: Embraces teamwork, supports and encourages positive change while giving value to individuals.Cost - Conserves organization resources; Understands fiscal responsibility; Works within approved budget; Develops and implements cost saving measures; contributes to profits and revenue.EDUCATION & EXPERIENCE High school diploma or equivalent required. Two years of related experience. CERTIFICATION/LICENSURE Certified Professional Coder (CPC), or related certification preferred.ADDITIONAL REQUIREMENTSPassing the Drivers License Check and/or Credit Check (for those positions requiring).Passing the WI Caregiver Background Check and/or IL Health Care Workers Background Check.Must be able to follow written/oral instructions.WORK ENVIRONMENTThe noise level in the work environment is usually quiet.0 Occupational Exposure: Category A - All partners in the specified job classification have occupational exposure.0 Occupational Exposure: Category B -Some partners in the specified job classification have occupational exposure.1 Occupational Exposure: Category C - No partners in the specified job classification have occupational exposure.AGE OF PATIENTS SERVED (these will be checkboxes)1 Neonate (birth 28 days)1 Infant (29 days less than 1 year)1 Pediatric (1 year 12 years)1 Adolescents (13 years 17 years)1 Adult (18 years 64 years)1 Geriatric (65 years and older)1 Non-Specific Task (N/A)INFORMATION ACCESSPartner may access patient care information, financial data, human resource data and strategic and planning data needed to perform their job duties as directed by the director.WORK CONTACT GROUP Partners, physicians, patients/family, visitors, vendors SPECIAL PHYSICAL DEMANDSThe Special Physical Demands are considered Essential Job Functions of the position with or without reasonable accommodations.While performing the duties of this job, the employee is regularly required to use hands to finger, handle, or feel; reach with hands and arms and talk or hear. The employee must be able to hear at high and low levels through voice and telephone communications to be able to respond to patients and partners. The employee is frequently required to sit. The employee is occasionally required to stand; walk; climb; or balance and stoop, kneel, crouch, or crawl. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus. While performing the duties of this job, the employee must have good manual dexterity to operate keyboard and telephone; repetitive finger/wrist movement associated with use of keyboard. Requires exerting 25 to 50 pounds of force occasionally, and lifting up to 10 to 15 pounds frequently.LEVEL OF SUPERVISIONWill be supervised by Revenue Cycle supervisors and managers.SUPERVISESN/A

Keywords: Mercyhealth, Janesville , CHARGE ENTRY ANALYST, Professions , Janesville, Wisconsin