Posted in Other about 15 hours ago.
Facility: VIRTUAL-GA
Job Summary: Under direction of the Director of Revenue Management, this position is responsible for performing defensive, concurrent, retrospective and patient requested bill audits to determine accuracy of billed charges. Provide timely answers to patient questions to enhance customer service. Interact with all hospital departments with lost charge problems and provide education on issues to prevent reoccurence. Complete and review productivity and departmental reports.
Core Responsibilities and Essential Functions: Perform concurrent medical record audits. * Review and interpret clinical documentation to verify charge on claim * Review account financials for accuracy. * Adjust claims if audit finding identifies errors in billing or compliance issues. * Review and adjust Medicare Observation Status carve out minutes Perform retrospective audits * Work with payer to negotiate proper adjustment to claim. * Review account financials for accuracy. * Adjust claims if audit finding identifies discrepancies. * Review Defense Audits * Review Payor request Audits as need * Review Pre-Bill Audits * Handle customer service referrals * Perform other duties as assigned * Perform Focus Audits to identify trends in charging errors Educate clinical and support services * Report trends and charge errors to RMD Director and Executive Director * Work with projects team to formulate education plan and presenting education sessions for appropriate departments Performs other duties as assigned Complies with all WellStar Health System policies, standards of work, and code of conduct.
Required Minimum Education: Graduate of accredited Licensed Practical Required or Registered Nursing program with license to practice in Georgia Required
Required Minimum License(s) and Certification(s): All certifications are required upon hire unless otherwise stated.
The Judge Group Inc. |
The Judge Group Inc. |
The Judge Group Inc. |