Overview
Combines strong analytical skills with intermediate to advanced excel applications to construct and analyze data for a variety of business and operational issues, to include budgeted collection rates, managed care contracts, government carrier fees, internal pricing fee schedules, new business modeling, and supply capture monitoring. Responsible for formatting data into flat files for import into EPIC and converting fee schedules into smaller, user-friendly .pdf files for distribution. Serves as a coding and reimbursement information resource for providers and staff, to ensure appropriate application of CPT, HCPCS and ICD-10 coding changes that affect the various groups. Responsible for auditing various functions and products (i.e., electronic medical records, Research Guarantor Accounts) to ensure correct billing and documentation standards are being met.
Responsibilities
Construct and manipulate large data files for assigned
departments, applying intermediate to advanced functions
(pivot tables, v-lookups and other complex formulas) to
produce reports necessary for contract negotiations,
budgeting and other financial and business decisions.
Develop, maintain, and update charge capture forms
(including superbills) in PageMaker or other publication
software.
Provides EPIC Resolute Professional Billing function, design,
and build expertise needed for successful product
implementation, upgrades and troubleshooting support in
relation to various EPIC master files and modules (i.e EAP,
MOD, RSH, SER).
Establish and implement quality assurance processes.
Maintain statistics for production and accuracy. Supervise the
daily activities of the Reimbursement Analysts and ensure the
completeness and accuracy of their work. Identify and correct
errors made by the staff and assist the manager with
monitoring and recording of staff work productivity. Train staff
on job duties and workflow processes. Ensure all job duties
have coverage when personnel are on vacation or ill. Handle
daily personnel issues as requested by the Manager.
Audit Research Patient Personal/Family accounts and
Research Guarantor accounts to ensure registration have not
corrupted the accuracy of the data. Make corrections and
move transactions as appropriate. Provide feedback to the
coordinator or registration staff as needed.
Develop appropriate modifications to master files to improve
existing workflow by identifying gaps between current outputs
and expected requirements. Independently and in
collaboration with IS counterparts, generates ideas, and
implements solutions.
Research payer policies, audit charts or notes, and apply coding and billing concepts to complex or new scenarios to
provide Business Groups, Pre-Admission Specialists, and
Physicians guidance on proper coding and billing.
Creates and executes project work plans and revises as
appropriate to meet changing needs and requirements for
several recurring major projects each year. Coordinate with
various team members in and out of the Reimbursement
Department to accomplish results.
Review Research Study Initiation Request Forms (RSIRFs)
for proper coding and pricing.
Establish the CMS I&A Connection and maintain EHR
Registration and Attestation System connections and data for
every provider for whom we are attesting Meaningful Use.
Complete the Medicaid Meaningful Use Attestation on the FL
MMIS site for each eligible provider and respond to ACHA
audit requests as appropriate.
Qualifications
Experience Requirements:
3 years Medical billing/claims experience including coding, medical terminology, and third party reimbursement required
1 year Microsoft Office experience essential (proficient to expert skill in Excel). required
1 year Experience analyzing and manipulating large data sets. preferred
Up to 1 year Working knowledge of Quality Payment Programs (i.e., MIPS, Medicaid EHR Incentive). preferred
1 year Experience with management information systems and medical software; prior Epic systems preferred required
1 year supervisory experience preferred
Education: High School Diploma or GED equivalent required Associates preferred
Certification/Licensure:
Certified Professional Coder (CPC) required or within 6 months
Epic Certification PB required and within 6 months EPIC Certification required must pass within three (3) attempts to maintain employment
New Version Training (NVT) required must pass within three (3) attempts to maintain employment Supervises: 1-5 Reimbursement Analyst Additional Duties:
Additional Duties as assigned may vary.
UFJPI IS AN EQUAL OPPORTUNITY EMPLOYER AND DRUG FREE WORKPLACE