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Advocate Aurora Health · 2 days ago

Prebilling Coding Specialist - Revenue Cycle

United States

Full-time

Remote

Mid Level

$24.85/hr - $37.30/hr

3+ years exp

Advocate Aurora Health is the third-largest nonprofit, integrated health system in the United States, providing comprehensive care across multiple states. They are seeking a Prebilling Coding Specialist to join their Revenue Cycle team, responsible for ensuring accurate claim generation and maintaining compliance with coding standards and regulations.

Health Care

Responsibilities

Edit and correct or coordinate the correction/review of edits generated on the 3M OCE/EAPG report

Based upon a daily review of the OCE/EAPG report, review alert against patient record to determine the appropriateness of corrections to patient's accounts

Make revisions with the utmost attention to accuracy to ensure correct claim generation

Demonstrate and maintain proficiency in what constitutes an appropriate correction to a patient's account, the appropriate party to make the correction, and the data which substantiates a correction

Document activities in a clean and concise manner in the Allegra system

Responsible for the filing, security, confidentiality, retention and storage of all government and private documents initiated in unit

Combine accounts according to payer requirements when appropriate

Correctly identify when accounts are related or unrelated services by reviewing the clinical data contained in the patient's medical record

Review and combine accounts in a timely manner, specifically, prior to the generation of the claim

Demonstrate and maintain proficiency in properly combining accounts and/or charges according to payer policies and regulations

Contacts physicians and other health care professionals and hospital department representatives to obtain needed information required for the correct assignment of CPT-4/HCPCS, modifiers and charges for outpatient services

Responsible to read and understand all Advocate SRCO policies and departmental collections policies and procedures

Maintains knowledge of HIPAA regulations within the scope of the position and carry out job duties in a manner consistent with these regulations ensuring action is taken within guidelines set forth

Must attend and participate in and understand information presented at department meetings

Directs all questions or needs for clarification to management to ensure training needs are readily identified and addressed

Identifies and makes recommendations for process improvements

Responsible to read and understand all correspondence from Government Regulatory Agencies, Payer Updates, etc

Keeps abreast of all system requirements and changes. Achieves proficiency in all applicable functions of the patient accounting systems

Assists in completing ad hoc projects and related job activities as assigned to support department operations. During periods of high volume and/or impending deadlines, assignments may include assisting with patient accounting activities and functions typically performed by other SRCO positions

Maintains current knowledge of ICD-CM and CPT/HCPCS coding systems, as well as APCs and other outpatient reimbursement methodologies and maintains coding credential certification and maintains HIM and/or coding certification credential with AHIMA

Attends internal and external educational seminars and inservices to satisfy continuing education requirements and maintain certification

Reviews the periodicals provided to remain abreast of changes that will affect coding and reimbursement methodologies

Participates in peer review activities to assess coding and abstracting accuracy

Responsible for personal and professional growth and development

Seeks assignments and special projects to facilitate growth towards potential advancement

Keeps abreast of current practices via literature, educational offerings, professional affiliations, etc

Acquires and maintains knowledge of all insurance regulations, local, state, and federal legislation and regulatory agencies and activities which may affect SRCO operations

Qualification

Outpatient Coding ExperienceCCSCCS-P CertificationICD-CMCPT/HCPCS Knowledge3M OCE Report ExperienceAnalytical SkillsComputer ExperienceAttention to DetailCritical ThinkingCollaboration Skills

Required

Certified Coding Specialist (CCS) credential for inpatient or outpatient coding positions or Certified Coding Specialist-Physician based (CCS-P) for outpatient coding positions

Completion of coding certificate program from recognized community college (typically 20 semester hours of college credit courses) or significant coding experience prior to earning CCS or CCS-P credential

Registered Health Information Technician (RHIT) with associate's degree in health information technology from accredited program or Registered Health Information Administrator (RHIA) with bachelor's degree in health information administration from accredited program

3-5 years of recent acute care hospital outpatient coding experience

Experience with the 3M OCE report or experience in charge capture determination in a complex department such as the emergency department

Achieve satisfactory score on Advocate's coding test

Attention to detail (such as interpretation of clinical data including medical terminology and disease processes)

Analytical skills for abstracting of clinical data

Ability to interpret regulatory and payer rules and directives concerning coding

Computer experience

CCS, CCS-P, RHIT/RHIA