Apply on Employer Site

Covenant Health · 2 months ago

CHARGE SOLUTIONS ANALYST I

Knoxville, TN

Full-time

Onsite

Entry Level

1+ years exp

Covenant Health is East Tennessee’s top-performing healthcare network, and they are seeking a Charge Solutions Analyst I to analyze and resolve claim processing issues. The role involves ensuring compliance with regulatory guidelines and maintaining knowledge of coding, charging, and billing practices.

Health CareHealth InsuranceHome Health Care

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 agency’s 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 timely manner to allow correction prior to claim processing

Performs departmental monitoring to ensure compliance. Accepts feedback and education from monitoring results and Revenue Integrity audits as a learning opportunity. Takes appropriate action to follow through with corrections to the account

Effectively manages tasks and project assignments using prioritization and time management skills. Communicates to Sr. Charge Solutions Analyst concerns or when assistance with prioritization and timelines are needed

Effectively uses and monitors the compliance of electronic tools used to determine the appropriate charges

Recognizes situations, which necessitate supervision and guidance, seeking and obtaining appropriate resources

Participates in professional growth and development through continuing education, seminars, and applicable professional affiliations to keep informed in industry trends. Attends department meetings regularly

Displays willingness to generate a positive and harmonious relationship with all co-workers. Promotes good public relations and has a positive impact to the culture of the department and Finance Division

Assists with special projects/tasks

Follows policies, procedures, and safety standards. Completes required education assignments annually. Works toward achieving goals and objectives, and participates in quality improvement initiatives as requested

Performs other duties as assigned

Qualification

Claims ProcessingCPT CodingRegulatory ComplianceHealthcare KnowledgeAnalytical SkillsPublic RelationsPC ProficiencyMicrosoft ExcelMicrosoft WordProblem SolvingTime ManagementTeam Collaboration

Required

One (1) to three (3) years of experience in charging, coding, or billing required

General understanding of healthcare, documentation, compliant charging practices, rules, regulations, and guidelines

Experience in problem solving and analytical reviews

Must be knowledgeable in use of PCs, Windows, Excel, and Word Processing

Must have good public relations skills

Preferred

Associate's degree preferred or equivalent experience sufficient to demonstrate possession of the knowledge, skill, and ability needed to perform the essential tasks of the job