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Posted: Thursday, December 28, 2017 11:19 AM

Req ID:14663
Shift: Days
Employment Status:AF : Active : Regular : Full Time
Job Summary 13;
Under the supervision of the Billing Manager and Billing Supervisor, the individual is responsible for accurate coding of hospital outpatient services according to national coding guidelines. Resolve NCCI edits that are holding patient claims from billing, by reviewing coding protocols. Analyze data for ancillary departments and identify payor trends to prevent denials that delay reimbursement or cause rework within the Billing Department. In conjunction under the direction of Revenue Integrity the Billing Analyst contact hospital departments to resolve outstanding claims related to coding and charge entry edits as appropriate.

Billing Edit Analyst is considered a subject matter expert for resolving all National Coding (NCCI) edits that impact timely submission of claims and reimbursement.
Job Responsibilities 13;
Performs tasks required to ensure the timely and accurate submission of insurance claims to all third party payors and documents billing activity in EPIC and Billing Editor. Tasks include:
:Managing National Correct Coding Initiative (NCCI) edit work queues by insurance payors.
:Review and correct identified NCCI and other payer coding edits during the claim edit review process prior to submission to the payer.
:Resolve edits by adding appropriate modifiers when required or takes other appropriate action.
:Work with Revenue Integrity Manager to resolve charge edits as appropriate
:Ensure all NCCI edits are resolved within 2 business days to ensure claims are submitted within 5 days from discharge date.
:Trend charges edits by ancillary department and collaborate with Revenue Integrity to resolve charge edits as appropriate.
:Analyzes billing error and denial data to identify root causes. Executes on work plans to correct identified deficiencies.
:Work with Patient Financial Services (PFS) and Revenue and Reimbursement to review coding denials and determine if case(s) should be appealed or resubmitted according to appropriate coding guidelines provided by the insurance payor.
:Work closely with HIM on outpatient coding and utilizing 3M application as appropriate
:Analyzes changes to coding and billing rules and regulations by utilizing appropriate reference materials, internet sources, seminars and publications. Executes on work plans to adapt systems and processes to accommodate changes.
:Updating account resolution in EPIC and promptly notifying Billing Management team if there are trends identified or patterns that may impact delay in payment.

Required Licenses, Certifications, Registrations 13;
CPC / CPCH Certification 13;
Required Education and Experience 13;
B.S. in Business, Finance, Accounting, or related field of study
Expertise in ICD:9, ICD:10, CPT:4, HCPCS coding, NCCI edits and modifier usage.
Minimum of 2 years claim edit coding experience in a healthcare setting.
Preferred Education, Experience and Cert/Lic 13;
Preferred Licenses/certificates/registrations: CCS, RHI or RHITA
Additional Technical Requirements 13;
:General knowledge of payer requirements / regulations
:Knowledge of hospital billing codes (Revenue, HCPCS, CPT, and understanding of EOBs is required.
:Ability to resolve NCCI edits:understanding when to append a modifier or adjust a charge(s).
:Understanding of CDM driven codes vs. HIM assigned codes.
:Prior billing experience or general familiarity with the UB04 claims form.
:Familiarity with or ability to research in the NCCI Policy Manual and Medicare Manuals.
:Must adhere to HIPAA compliance.
:Excellent interpersonal skills and the ability to communicate with payors and internal customers are a must
:The ability to problem solves and analyzes billing data.
:Demonstrate proficiency in relevant software applications, including Microsoft suite.
:Requires a high degree of


• Location: South Jersey

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