- Refer to Job Summary for Qualifications
Altru Health System is committed to achieving Organizational Excellence and expects each employee to actively participate in the achievement of the departmental goals associated with the 5 Pillars of Excellence – Service, Quality, People, Finance and Growth.
The Reimbursement and Recovery Specialist is responsible for analysis regarding revenue improvements and opportunities; will audit charges and coding in order to ensure compliance, as well as optimal reimbursement along with verification of charges through each department to determine correct charging or any incorrect charging trends, also analyze reimbursement to determine any under or over payments and take appropriate action to determine the source of discrepancy; will complete financial analysis when requested by staff and will notify appropriate staff regarding any reimbursement or charging issues in order to ensure compliance; will stay up to date on payer guidelines and educate and act as a resource regarding coding, billing, and documentation guidelines from all government and third party contracted payers.
Primary Job Duties:
- Performs auditing of charges to ensure billing compliance and optimal reimbursement; perform specific departmental analysis of charges to determine correct codes/charges are being utilized, if discrepancies found, work with appropriate staff to correct any trending issues.
- Perform random auditing of coding to ensure compliance and optimal reimbursement.
- Recognize opportunities for improvements in coding and billing for increased revenue opportunities.
- Evaluate reimbursement for under/overpayments according to our contracted rates.
- Assist in preparation of reports and report analysis for staff when requested for reimbursement and utilization issues.
- Complete financial analysis when requested regarding reimbursement and compliance issues or opportunities.
- Research new/revised Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) codes to ensure correct billing setup within chargemaster.
- Education of staff regarding compliance in coding and billing.
- Education of staff regarding recognizing appropriate reimbursement.
KNOWLEDGE & SKILLS REQUIRED :
• Bachelor of Science or Bachelor of Business Administration degree or equivalent work experience.
• Knowledge of Current Procedural Terminology (CPT), International Classification for Diseases (ICD-9), Healthcare Common Procedure Coding System (HCPCS), and revenue codes.
• Ability to abstract patient charges for correct coding for auditing purposes.
• Knowledge of insurance reimbursement methodologies.
• Knowledge of medical terminology and procedures.
• Knowledge and/or experience with healthcare billing practices.
• Experience with healthcare system analysis.
• Demonstrates effective communication, both verbal and written.
• Ability to work independently and on multiple projects at one time.
• Experience and knowledge working with Excel, Word, and PowerPoint.
• Accredited by the American Health Information Management Association (AHIMA) as an Registered Health Information Technician (RHIT)/Registered Health Information Administrator (RHIA), and/or
• Certified by the American Academy of Professional Coders (AAPC) as a Certified Coding Specialist (CCS) or Certified Professional Coder (CPC).
SUPERVISION RECEIVED :
Supervision is received from the Manager of Reimbursement and Budget, and Third Party Contracts.