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MD Anderson Cancer Center Regional Billing Specialist - Ambulatory Charge Capture Services in Houston, Texas

Regional Billing Specialist opportunity in Ambulatory Charge Capture Services department. The ideal candidate will have an Associate's degree and four years professional fee billing experience in healthcare or insurance field.

Prefer candidates with ambulatory professional billing experience with physician's practice and/or hospital facility to include, but not limited to, charge and documentation review and auditing to ensure accuracy of charges; Epic EMR experience is a plus.

SUMMARY

The position is responsible for the charge capture and reconciliation processes for both professional and technical charges for multi-specialty oncology service lines. Responsible for ensuring accurate and timely charge capture, documentation and reconciliation in accordance with institutional policies, and applicable regulatory standards and requirements. Working knowledge of CPT codes is required.

Charge Capture and Reconciliation of Professional and Technical/Facility Charges

Responsible for daily Professional and Technical charge capture submission and reconciliation processes in assigned center(s) to ensure accurate and timely filing of charges in the billing system according to the institutional billing and charge submission policy.

Researches compliance issues, and coordinates compliance education routinely to management by providing recommendations to improve charge capture and documentation accuracy.

Maintains ongoing education of coding and billing changes in accordance to industry standards as well as Institutional Billing Compliance for CPT, ICD-10-CM and HCPCS codes.

Knowledgeable review of documentation to support both professional and technical charges with a good understanding of anatomy and medical terminology according to coding/billing and documentation guidelines as applicable to state and federal regulations.

Procedural Areas - Accurate capture of both professional and technical procedure charge logs for accurate charge submission for all services. Identifies and resolves issues impeding charge capture, monitors anesthesia PACU charges, supplies used and collaborates with clinical teams.

Reviews PACU recovery patient types, recovery times, and audit patient accounts to ensure appropriate billing and correct cost center allocation.

Review and resolve work queue edits in the billing system and any other documentation and billing software to ensure all charges are captured and dropped in a timely manner.

Professional Open Encounters - reviews as above but also compiles a list for each center all open encounters, sends emails to providers as designated and provides a summary for each center to management as outlined by the department.

Technical Open Encounters - reviews daily for open technical encounters. Contact nursing staff to close encounters in order to capture charges.

Communicates effectively with providers and nursing staff regarding missing or incomplete charges to ensure they are submitted correctly and timely.

Initiates charge corrections as appropriate. Determine corrective action and make necessary updates to resolve errors for appropriate billing of claims.

Communicate any inaccuracies or challenges identified immediately to the Manager which exist in creating barriers to meet institutional policy and timely charge capture.

Assist with analysis of Charge Description Master and maintenance to identify new supplies and ensure accuracy of charge entry on an on-going basis.

Maintains standardized workflows and productivity as designated by department management and institutional policies.

Professional Charge Capture and Reconciliation for Outside Facility Rounding Services

Performs all processes related to the charge capture, charge entry and reconciliation of professional charges for outside facility services for the Houston Area Location Faculty across all centers.

Obtain and maintain access to outside facility EMR for retrieval of billing information and medical records.

Retrieve and validate patient registration from outside facility ensuring accurate and concise completion including validation of patient demographics and insurance verification.

Obtain financial information needed to determine financial eligibility according to MD Anderson managed care contracts.

Retrieval of medical records from community hospital to support charges for each date and provider.

Abstraction of accurate CPT and ICD-10-CM codes to support documentation and charges.

Experienced professional behavior in communicating with providers, clinical support teams, staff, and management.

Notify Revenue Cycle Manager if patient's insurance is out of network for MD Anderson.

Project Management and Follow-Up

Assists in monitoring billing compliance and conducts staff education sessions as necessary.

Assist with analysis of Charge Description Master and maintenance to identify new supplies and ensure accuracy of charge entry on an on-going basis.

Assists in monitoring billing compliance and conducts staff education sessions as necessary.

Assists with collecting and summarizing data related to special projects.

Develops, implements, and monitors reconciliation and audit processes to ensure all inpatient and outpatient professional and technical charges are appropriately captured and provides reports of activities as required.

Identifies and communicate process improvement strategies, inaccuracies for resolution and corrective action to management in a timely and routine manner.

Assists with other duties as assigned.

Education

Required: Associate's degree in Business Administration or related field.

Preferred : None

E xperience

Required: Four years professional fee billing experience in healthcare or insurance field. May substitute required education degree with additional years of experience on a one to one basis.

Preferred: Ambulatory professional billing experience with physician's practice and/or hospital facility to include, but not limited to, charge and documentation review and auditing to ensure accuracy of charges. Experience using Epic EMR is a plus.

It is the policy of The University of Texas MD Anderson Cancer Center to provide equal employment opportunity without regard to race, color, religion, age, national origin, sex, gender, sexual orientation, gender identity/expression, disability, protected veteran status, genetic information, or any other basis protected by institutional policy or by federal, state or local laws unless such distinction is required by law. http://www.mdanderson.org/about-us/legal-and-policy/legal-statements/eeo-affirmative-action.html

Additional Information

  • Requisition ID: 145183

  • Employment Status: Full-Time

  • Employee Status: Regular

  • FLSA: exempt and not eligible for overtime pay

  • Work Week: Days

  • Fund Type: Hard

  • Remote Work: Remote (within Texas only)

  • Pivotal Position: No

  • Minimum Salary: US Dollar (USD) 44,000

  • Midpoint Salary: US Dollar (USD) 55,000

  • Maximum Salary : US Dollar (USD) 66,000

  • Science Jobs: No

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