Charge Solutions Analyst
Tempo pieno, 80 Hours Per Pay Period, Day Shifts
Position Summary
Responsible for analyzing, determining corrections, investigating causes, and leading actions to resolve claim processing issues. Uses CMS resources and source documentation as a compliance guide. Possesses and maintains a broad-based understanding of the clinical and business operations across a diverse group of hospitals and clinical departments. Works independently under limited supervision with significant latitude for initiative and independent judgement. Maintains all organizational and professional ethical standards. Performs additional tasks necessary to assist in the team's overall success.
Responsibilities
Responsible for analyzing claim conflicts, weighing options for presenting issue, independently determining the correct course of action, and responding appropriately to ensure compliance; meet regulatory guidelines for coding, charging, and billing; and with discernment for payment inducing decisions.
Leads discussions and efforts to resolve complex claim issues with the business office and/or health information management related to charging, modifier assignment, and billing edits.
Maintains knowledge and understanding of CMS NCCI Policies, Claims Processing Manual, CPT coding, and modifiers to ensure compliance with Medicare, Medicaid, and other State and Federal governmental agencies’ procedural and regulatory guidelines.
Independently resolves suspended, failed, and erroneous charges from the use of incorrect clinical documentation workflow.
Responsible for investigation, cause analysis, and account corrections when charges are erroneously posted (i.e., duplicated, net negative). Follows appropriate process for identifying related accounts from reports, delayed claims, and/or project assignments.
Reviews and reconciles charge activity initiated by the Charge Solutions team for accuracy. Performs this daily with precision and addresses any discrepancies in a tim