Reimbursement Specialist - Medical Billing

Job Category: Revenue Cycle

Work Shift/Schedule:

Northeast Georgia Health System is rooted in a foundation of improving the health of our communities.

About the Role:

Job Summary

This position is responsible for facilitating proper charge capture in accordance with standard billing policies and clinical documentation practices through the use of the hospital's electronic information systems, manual processes, and review of the medical record. Identifies inconsistencies in medical reports and works with healthcare staff to improve charge capture and error correction. Follows compliant charge capture program and billing practices in accordance with Medicare, Medicaid, or Third Party payor guidelines. All functions of this role shall be performed within the guidelines of the department and hospital policies.

Minimum Job Qualifications

• Licensure or other certifications:

• Educational Requirements: High School Diploma or GED

• Minimum Experience: Minimum two (2) years hospital, medical, or billing experience.

• Other:

Preferred Job Qualifications

• Preferred Licensure or other certifications:

• Preferred Educational Requirements: Working knowledge of medical terminology, anatomy, physiology, medications, and CPT/HCPCS.

• Preferred Experience: Charge entry/capture experience, working knowledge or hospital policies and procedures, and experience with McKesson.

• Other:

Job Specific and Unique Knowledge, Skills and Abilities

• Working knowledge or Microsoft Office products required

• Understanding of the composition of a medical record, and the ability to read and interpret it is essential

• Displays problem solving ability, initiative, reasoning ability, decision making techniques, is detailed oriented, and appropriate use of resources

• Demonstrated ability to interact professionally on the phone and in person with staff, doctors, and supporting departments.

Essential Tasks and Responsibilities

• Identify all chargeable ED services and supplies.

• Calculate ED Evaluation and Management (E&M) level.

• Identify infusion, injection, and transfusion charges per existing Current Procedural Terminology (CPT) hierarchy guidelines for ED and outpatient/bedded outpatient services.

• Enter charges, quantities, and modifiers, when indicated, within 72 hours of the patient's discharge.

• Maintains greater than 97% completion rate of charges in less than 72 hours.

• Identify deficiencies or discrepancies in nursing and/or physician documentation that affects billing and notifies the originator of the incorrect documentation to allow for proactive improvements related to charge capture.

• Collaborate with Nurse Auditor on routine and special project analysis to assure the accuracy and completeness of charges captured for insurance and patient billing of inpatient and outpatient hospital services.

• Assist special projects related to charge capture and rebill projects.

• Collaborate and assist other departments to address charge capture/documentation issues and assist with the development of educational opportunities.

• Serve as a communication link between clinical/billing personnel and other reimbursement specialists in discussing issues, recommendations, solutions, and answering questions related to patient charges, auditing, and charge master.

• Perform other duties as assigned.

Physical Demands

• Weight Lifted: Up to 20 lbs, Occasionally 0-30% of time

• Weight Carried: Up to 20 lbs, Occasionally 0-30% of time

• Vision: Moderate, Occasionally 0-30% of time

• Kneeling/Stooping/Bending: Occasionally 0-30%

• Standing/Walking: Frequently 31-65%

• Pushing/Pulling: Occasionally 0-30%

• Intensity of Work: Frequently 31-65% %

• Job Requires: Reading, Writing, Reasoning, Talking, Keyboarding

Working at NGHS means being part of something special: a team invested in you as a person, an employee, and in helping you reach your goals.

NGHS: Opportunities start here.

Northeast Georgia Health System is an Equal Opportunity Employer and will not tolerate discrimination in employment on the basis of race, color, age, sex, sexual orientation, gender identity or expression, religion, disability, ethnicity, national origin, marital status, protected veteran status, genetic information, or any other legally protected classification or status.