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Develop new procedures related to HCC coding and assist with implementation of systems that impact coding, such as 3M#s Ambulatory Module# Research payer guidelines or regulatory guidelines that impact coding (ICD10 or CPT) and provide education for Ambulatory Coding Department related to those issues, understanding of claim edits, and denials by payers for coding reasons, to help prevent future denials.
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Knowledge of medical terminology, coding procedures, CPT and ICD-10, billing functions, cashier and data entry. Obtains pre-authorization or pre-certification for coverage of office visit or surgical procedure with appropriate ICD-10 and CPT codes needed.
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Familiar with Centricity Business (CBiz), Electronic Medical Record EMR), Phreesia, Referral Management System (RMS), Cerner and AVAYA phone systems. By October 1 of each year, institutions must publish and distribute their Annual Campus Security Policy & Crime Statistics Report (ASR) to current and prospective students and employees.
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Laboratory Operational Support- The laboratory Genetic Counselor will assist Laboratory Directors and Managers in the development of clinical and laboratory policies for new laboratory testing, ordering, CPT coding, billing and genetic testing reimbursement.
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Ability to improve APC/HCC assignments specific to medical necessity documentation & coding of PDx, SecDx, and CPT/HCPCS in accordance with official coding laws, regulations, rules, guidelines, and conventions.
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Experience with analyzing and/or auditing Revenue Cycle functions; including, but not limited to, ICD-10, CPT, and HCPCS coding accuracy, Medicare policy requirements, and any other operational workflows affecting billing accuracy for hospital or physician claims.
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Keeps abreast with all the changes in the CPT coding, CMS regulations, local Medicare carrier (Novitas) in order to provide the most accurate information when participating in any internal and external projects/discussions.
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The Insurance Collections Specialist is responsible for timely, accurate, and comprehensive billing of all provider services utilizing appropriate CPT procedures and ICD-10 diagnosis codes, composing appeals to overturn denied claims as well as collecting, posting, and managing account payments.
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The primary purpose of the Coding Specialist II is to code and verify charge data necessary to ensure correct coding, abstracting, and billing on emergency department (ED), same day surgery (SDS), outpatient clinic (OPC), observation (OBS), specialty clinics and/or inpatient OB/newborn encounters.
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Interacts directly with EPIC Auth/Cert, Registration and Referral Shell, entering data accurately to coordinate all elements required for payment of services rendered, which includes, but is not limited to, appropriate CPT Procedure and Diagnosis codes, rendering Physician(s), level of care, and facility, i.e., across entities (BWH, BWFH, FXB, etc.
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Knowledge of clinical operations, billing, and codingFamiliarity with CPT, HCPCS, ICD-10 coding, revenue codes, and hospital billing/claims processingKnowledge of Medi-Cal financing rules and regulations and Medi-Cal waiver reimbursementStrong critical thinking, financial analysis, and problem-solving abilitiesComputer proficiency with Microsoft OfficeBackground in report writing and working with large data preferredExcellent communication and leadership skills.
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Self-motivated, detail-oriented, and highly-analyticalBachelors degree in accounting, business, economics, math, or a related fieldSeven or more years of directly-related experienceFive or more years of experience in revenue/accounts receivable financial analysis, claims or billing analysis, decision support, or economics in a healthcare settingExperience with net revenue, Crowe revenue analytics tool, and provider enrollment.
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Prepare the annual system-wide net revenue budgetAnalyze reports and variances to determine deviations from trend/budgetPrepare month-end journal entries to report the value of Medicare, Medi-Cal, contracts, and other payor revenue and accounts receivableEnsure fee-for-service estimates are correctPerform quarterly analysis of FTEs for GME/IME reportingProvide training to staff on specific areas of expertise.
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Responsible for determining contractual and bad debt reserve estimates using the Crowe RCA tool and our accounts receivable model. Hospital Net Revenue Analyst. Collaborate closely with budget, contract management, revenue cycle, operations, and decision support to resolve net revenue issues.
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Our deep expertise in human capital management has fueled our expansion into direct hire placements, temporary staffing, contract placements, and additional staffing and consulting services that propel our clients businesses forward.
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