Charge Reconciliation Analyst

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      "city": "Description Job Summary: General Description: This is a dual department position performing services in both Patient Financial Services and Health Information Management Coding with shared work responsibilities. Essential Values-Based",
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    "jobTitle": "Charge Reconciliation Analyst",
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    "description": "<p><span style=\"font-size:12pt\"><span new=\"\" roman=\"\" style=\"font-family:\" times=\"\"><b><span style=\"font-size:11.0pt\"><span style=\"text-transform:uppercase\">Job Summary:</span></span></b></span></span></p>\r\n\r\n<p><span style=\"font-size:12pt\"><span new=\"\" roman=\"\" style=\"font-family:\" times=\"\"><b><span style=\"font-size:11.0pt\">General Description:</span></b></span></span></p>\r\n\r\n<p><span style=\"font-size:12pt\"><span new=\"\" roman=\"\" style=\"font-family:\" times=\"\"><span style=\"font-size:11.0pt\">This is a dual department position performing services in both Patient Financial Services and Health Information Management Coding with shared work responsibilities.</span></span></span></p>\r\n\r\n<p><span style=\"font-size:12pt\"><span new=\"\" roman=\"\" style=\"font-family:\" times=\"\"><b><span style=\"font-size:11.0pt\"><span style=\"text-transform:uppercase\">Essential Values-Based, Leadership and Management Competencies:</span></span></b></span></span></p>\r\n\r\n<p><span style=\"font-size:12pt\"><span new=\"\" roman=\"\" style=\"font-family:\" times=\"\"><span style=\"font-size:11.0pt\">At Artesia General Hospital, our leadership and management practices are grounded in our core values, captured in the acronym <b>S.E.R.V.I.C.E.</b> These values are the foundation of all employee activities and guide us in fulfilling our Mission.</span></span></span></p>\r\n\r\n<ul>\r\n\t<li><span style=\"font-size:12pt\"><span new=\"\" roman=\"\" style=\"font-family:\" times=\"\"><b><span style=\"font-size:11.0pt\">Servant Leadership </span></b><span style=\"font-size:11.0pt\">&ndash; Leading by serving others with compassion and humility. </span></span></span></li>\r\n\t<li><span style=\"font-size:12pt\"><span new=\"\" roman=\"\" style=\"font-family:\" times=\"\"><b><span style=\"font-size:11.0pt\">Excellence </span></b><span style=\"font-size:11.0pt\">&ndash; Striving for the highest quality in all we do. </span></span></span></li>\r\n\t<li><span style=\"font-size:12pt\"><span new=\"\" roman=\"\" style=\"font-family:\" times=\"\"><b><span style=\"font-size:11.0pt\">Respect </span></b><span style=\"font-size:11.0pt\">&ndash; Treating everyone with dignity and kindness. </span></span></span></li>\r\n\t<li><span style=\"font-size:12pt\"><span new=\"\" roman=\"\" style=\"font-family:\" times=\"\"><b><span style=\"font-size:11.0pt\">Virtuousness </span></b><span style=\"font-size:11.0pt\">&ndash; Acting with honesty, integrity, and accountability. </span></span></span></li>\r\n\t<li><span style=\"font-size:12pt\"><span new=\"\" roman=\"\" style=\"font-family:\" times=\"\"><b><span style=\"font-size:11.0pt\">Innovation </span></b><span style=\"font-size:11.0pt\">&ndash; Embracing new ideas to improve care and outcomes. </span></span></span></li>\r\n\t<li><span style=\"font-size:12pt\"><span new=\"\" roman=\"\" style=\"font-family:\" times=\"\"><b><span style=\"font-size:11.0pt\">Community </span></b><span style=\"font-size:11.0pt\">&ndash; Fostering collaboration to meet the needs of those we serve. </span></span></span></li>\r\n\t<li><span style=\"font-size:12pt\"><span new=\"\" roman=\"\" style=\"font-family:\" times=\"\"><b><span style=\"font-size:11.0pt\">Education </span></b><span style=\"font-size:11.0pt\">&ndash; Promoting learning and professional development. </span></span></span></li>\r\n</ul>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p><span style=\"font-size:12pt\"><span new=\"\" roman=\"\" style=\"font-family:\" times=\"\"><b><span style=\"font-size:11.0pt\">ESSENTIAL FUNCTIONS:</span></b> </span></span></p>\r\n\r\n<p><span style=\"font-size:12pt\"><span new=\"\" roman=\"\" style=\"font-family:\" times=\"\"><span style=\"font-size:11.0pt\">To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required.</span></span></span></p>\r\n\r\n<ul>\r\n\t<li style=\"margin-bottom:11px; margin-left:8px\"><span style=\"font-size:12pt\"><span style=\"line-height:115%\"><span style=\"text-autospace:ideograph-numeric ideograph-other\"><span new=\"\" roman=\"\" style=\"font-family:\" times=\"\"><span style=\"font-size:11.0pt\"><span style=\"line-height:115%\">Coordinating and completing line-item charge reviews of patient encounters to ensure accuracy and completeness for insurance and patient billing.</span></span></span></span></span></span></li>\r\n\t<li style=\"margin-left:8px\"><span style=\"font-size:12pt\"><span style=\"line-height:115%\"><span style=\"text-autospace:ideograph-numeric ideograph-other\"><span new=\"\" roman=\"\" style=\"font-family:\" times=\"\"><span style=\"font-size:11.0pt\"><span style=\"line-height:115%\">Verifies and resolves charge discrepancies by utilizing the tools and resources available. Ensures prompt corrections, reimbursements and adjustments as identified. </span></span></span></span></span></span></li>\r\n\t<li style=\"margin-left:8px\"><span style=\"font-size:12pt\"><span style=\"line-height:115%\"><span style=\"text-autospace:ideograph-numeric ideograph-other\"><span new=\"\" roman=\"\" style=\"font-family:\" times=\"\"><span style=\"font-size:11.0pt\"><span style=\"line-height:115%\">Reviewing outpatient and inpatient visits compared to what is billed and communicating with the coding department as well as the other department Mangers if there are discrepancies found.</span></span></span></span></span></span></li>\r\n\t<li style=\"margin-left:8px\"><span style=\"font-size:12pt\"><span style=\"line-height:115%\"><span style=\"text-autospace:ideograph-numeric ideograph-other\"><span new=\"\" roman=\"\" style=\"font-family:\" times=\"\"><span style=\"font-size:11.0pt\"><span style=\"line-height:115%\">Collaborate with the department&rsquo;s clinical and business colleagues in the development and implementation of educational activities related to charge- capture improvements. </span></span></span></span></span></span></li>\r\n\t<li style=\"margin-left:8px\"><span style=\"font-size:12pt\"><span style=\"line-height:115%\"><span style=\"text-autospace:ideograph-numeric ideograph-other\"><span new=\"\" roman=\"\" style=\"font-family:\" times=\"\"><span style=\"font-size:11.0pt\"><span style=\"line-height:115%\">Works with finance areas such as accounts billable, accounts receivable, registration staff, etc. to continuously improve processes for patient charge identification.</span></span></span></span></span></span></li>\r\n\t<li style=\"margin-left:8px\"><span style=\"font-size:12pt\"><span style=\"line-height:115%\"><span style=\"text-autospace:ideograph-numeric ideograph-other\"><span new=\"\" roman=\"\" style=\"font-family:\" times=\"\"><span style=\"font-size:11.0pt\"><span style=\"line-height:115%\">Assist with monthly claim denial review.</span></span></span></span></span></span></li>\r\n\t<li style=\"margin-left:8px\"><span style=\"font-size:12pt\"><span style=\"line-height:115%\"><span style=\"text-autospace:ideograph-numeric ideograph-other\"><span new=\"\" roman=\"\" style=\"font-family:\" times=\"\"><span style=\"font-size:11.0pt\"><span style=\"line-height:115%\">Work coding claim edits.</span></span></span></span></span></span></li>\r\n\t<li style=\"margin-left:8px\"><span style=\"font-size:12pt\"><span style=\"line-height:115%\"><span style=\"text-autospace:ideograph-numeric ideograph-other\"><span new=\"\" roman=\"\" style=\"font-family:\" times=\"\"><span style=\"font-size:11.0pt\"><span style=\"line-height:115%\">Review CCI edits and documentation to determine if modifiers are appropriate</span></span></span></span></span></span></li>\r\n\t<li style=\"margin-left:8px\"><span style=\"font-size:12pt\"><span style=\"line-height:115%\"><span style=\"text-autospace:ideograph-numeric ideograph-other\"><span new=\"\" roman=\"\" style=\"font-family:\" times=\"\"><span style=\"font-size:11.0pt\"><span style=\"line-height:115%\">Review claims edits for medical necessity.&nbsp; Review documentation for supporting diagnosis codes.</span></span></span></span></span></span></li>\r\n\t<li style=\"margin-left:8px\"><span style=\"font-size:12pt\"><span style=\"line-height:115%\"><span style=\"text-autospace:ideograph-numeric ideograph-other\"><span new=\"\" roman=\"\" style=\"font-family:\" times=\"\"><span style=\"font-size:11.0pt\"><span style=\"line-height:115%\">Review claim edits for MUE&rsquo;s (Medically Unlikely Edits) and determine appropriate correction.</span></span></span></span></span></span></li>\r\n\t<li style=\"margin-left:8px\"><span style=\"font-size:12pt\"><span style=\"line-height:115%\"><span style=\"text-autospace:ideograph-numeric ideograph-other\"><span new=\"\" roman=\"\" style=\"font-family:\" times=\"\"><span style=\"font-size:11.0pt\"><span style=\"line-height:115%\">Review claim edits to determine if claim should be sent to different department queues.</span></span></span></span></span></span></li>\r\n\t<li style=\"margin-left:8px\"><span style=\"font-size:12pt\"><span style=\"line-height:115%\"><span style=\"text-autospace:ideograph-numeric ideograph-other\"><span new=\"\" roman=\"\" style=\"font-family:\" times=\"\"><span style=\"font-size:11.0pt\"><span style=\"line-height:115%\">Compile user friendly Denials Management Report from Qlik Denials Management Report to aid in determining true, preventable denials that we could be placed into an action plan to decrease such denials.</span></span></span></span></span></span></li>\r\n\t<li style=\"margin-left:8px\"><span style=\"font-size:12pt\"><span style=\"line-height:115%\"><span style=\"text-autospace:ideograph-numeric ideograph-other\"><span new=\"\" roman=\"\" style=\"font-family:\" times=\"\"><span style=\"font-size:11.0pt\"><span style=\"line-height:115%\">Build and maintain a shared folder of payer policies for coding and medical necessity to aid in decreasing claim edits and denials based on these policies ICD-10 and CPT/HCPCS coding.</span></span></span></span></span></span></li>\r\n\t<li style=\"margin-left:8px\"><span style=\"font-size:12pt\"><span style=\"line-height:115%\"><span style=\"text-autospace:ideograph-numeric ideograph-other\"><span new=\"\" roman=\"\" style=\"font-family:\" times=\"\"><span style=\"font-size:11.0pt\"><span style=\"line-height:115%\">Review pending clinic accounts for complete documentation, signatures, etc.</span></span></span></span></span></span></li>\r\n\t<li style=\"margin-left:8px\"><span style=\"font-size:12pt\"><span style=\"line-height:115%\"><span style=\"text-autospace:ideograph-numeric ideograph-other\"><span new=\"\" roman=\"\" style=\"font-family:\" times=\"\"><span style=\"font-size:11.0pt\"><span style=\"line-height:115%\">Any other assigned duties.</span></span></span></span></span></span></li>\r\n</ul>\r\n\r\n<p><span style=\"font-size:12pt\"><span new=\"\" roman=\"\" style=\"font-family:\" times=\"\"><b><span style=\"font-size:11.0pt\">KNOWLEDGE/SKILL/ABILITIES: </span></b><span style=\"font-size:11.0pt\">Previous patient billing and patient record review with preferred coding experience.</span></span></span></p>\r\n\r\n<p><span style=\"font-size:12pt\"><span new=\"\" roman=\"\" style=\"font-family:\" times=\"\"><b><span style=\"font-size:11.0pt\">AGE-RELATED COMPETENCIES: </span></b><span style=\"font-size:11.0pt\">Demonstrates the basic knowledge and skills necessary to identify age-specific patient needs appropriate for this position.</span></span></span></p>\r\n\r\n<p style=\"margin-bottom:11px\"><span style=\"font-size:12pt\"><span style=\"line-height:115%\"><span style=\"text-autospace:ideograph-numeric ideograph-other\"><span new=\"\" roman=\"\" style=\"font-family:\" times=\"\"><b><span style=\"font-size:11.0pt\"><span style=\"line-height:115%\"><span style=\"text-transform:uppercase\">Information Management:</span></span></span></b><span style=\"font-size:11.0pt\"><span style=\"line-height:115%\"> Treats all information and data within the scope of the position while maintaining patient confidentiality and security. Complies with HIPAA and compliance guidelines established by Artesia General Hospital.</span></span></span></span></span></span></p>\r\n\r\n<p style=\"text-align:justify\"><span style=\"font-size:12pt\"><span new=\"\" roman=\"\" style=\"font-family:\" times=\"\"><b><span style=\"font-size:11.0pt\"><span style=\"text-transform:uppercase\">Risk Management/Quality Management/Safety:</span></span></b><span style=\"font-size:11.0pt\"> Cooperates fully in all Risk Management, Quality Management, and Safety Activities and Investigations.</span></span></span></p>\r\n\r\n<p>&nbsp;</p>\r\n",
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The requirements listed below are representative of the knowledge, skill, and/or ability required.\\r\\n\\r\\n\\r\\n\\tCoordinating and completing line-item charge reviews of patient encounters to ensure accuracy and completeness for insurance and patient billing.\\r\\n\\tVerifies and resolves charge discrepancies by utilizing the tools and resources available. Ensures prompt corrections, reimbursements and adjustments as identified. \\r\\n\\tReviewing outpatient and inpatient visits compared to what is billed and communicating with the coding department as well as the other department Mangers if there are discrepancies found.\\r\\n\\tCollaborate with the department&rsquo;s clinical and business colleagues in the development and implementation of educational activities related to charge- capture improvements. \\r\\n\\tWorks with finance areas such as accounts billable, accounts receivable, registration staff, etc. to continuously improve processes for patient charge identification.\\r\\n\\tAssist with monthly claim denial review.\\r\\n\\tWork coding claim edits.\\r\\n\\tReview CCI edits and documentation to determine if modifiers are appropriate\\r\\n\\tReview claims edits for medical necessity.&nbsp; Review documentation for supporting diagnosis codes.\\r\\n\\tReview claim edits for MUE&rsquo;s (Medically Unlikely Edits) and determine appropriate correction.\\r\\n\\tReview claim edits to determine if claim should be sent to different department queues.\\r\\n\\tCompile user friendly Denials Management Report from Qlik Denials Management Report to aid in determining true, preventable denials that we could be placed into an action plan to decrease such denials.\\r\\n\\tBuild and maintain a shared folder of payer policies for coding and medical necessity to aid in decreasing claim edits and denials based on these policies ICD-10 and CPT/HCPCS coding.\\r\\n\\tReview pending clinic accounts for complete documentation, signatures, etc.\\r\\n\\tAny other assigned duties.\\r\\n\\r\\n\\r\\nKNOWLEDGE/SKILL/ABILITIES: Previous patient billing and patient record review with preferred coding experience.\\r\\n\\r\\nAGE-RELATED COMPETENCIES: Demonstrates the basic knowledge and skills necessary to identify age-specific patient needs appropriate for this position.\\r\\n\\r\\nInformation Management: Treats all information and data within the scope of the position while maintaining patient confidentiality and security. Complies with HIPAA and compliance guidelines established by Artesia General Hospital.\\r\\n\\r\\nRisk Management/Quality Management/Safety: Cooperates fully in all Risk Management, Quality Management, and Safety Activities and Investigations.\\r\\n\\r\\n&nbsp;\\r\\nQualifications\\r\\n\\tEducation &ndash; High School Diploma\\r\\n\\tWork Experience &ndash; Billing &amp; Coding knowledge preferred.\\r\\n\\r\\n\\r\\nENVIROMENTAL CONDITIONS: Remote home conditions.\\r\\n\\r\\n&nbsp;\\r\\n\",\"responsibilities\":\"Job Summary:\\r\\n\\r\\nGeneral Description:\\r\\n\\r\\nThis is a dual department position performing services in both Patient Financial Services and Health Information Management Coding with shared work responsibilities.\\r\\n\\r\\nEssential Values-Based, Leadership and Management Competencies:\\r\\n\\r\\nAt Artesia General Hospital, our leadership and management practices are grounded in our core values, captured in the acronym S.E.R.V.I.C.E. These values are the foundation of all employee activities and guide us in fulfilling our Mission.\\r\\n\\r\\n\\r\\n\\tServant Leadership &ndash; Leading by serving others with compassion and humility. \\r\\n\\tExcellence &ndash; Striving for the highest quality in all we do. \\r\\n\\tRespect &ndash; Treating everyone with dignity and kindness. \\r\\n\\tVirtuousness &ndash; Acting with honesty, integrity, and accountability. \\r\\n\\tInnovation &ndash; Embracing new ideas to improve care and outcomes. \\r\\n\\tCommunity &ndash; Fostering collaboration to meet the needs of those we serve. \\r\\n\\tEducation &ndash; Promoting learning and professional development. \\r\\n\\r\\n\\r\\n&nbsp;\\r\\n\\r\\nESSENTIAL FUNCTIONS: \\r\\n\\r\\nTo perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required.\\r\\n\\r\\n\\r\\n\\tCoordinating and completing line-item charge reviews of patient encounters to ensure accuracy and completeness for insurance and patient billing.\\r\\n\\tVerifies and resolves charge discrepancies by utilizing the tools and resources available. Ensures prompt corrections, reimbursements and adjustments as identified. \\r\\n\\tReviewing outpatient and inpatient visits compared to what is billed and communicating with the coding department as well as the other department Mangers if there are discrepancies found.\\r\\n\\tCollaborate with the department&rsquo;s clinical and business colleagues in the development and implementation of educational activities related to charge- capture improvements. \\r\\n\\tWorks with finance areas such as accounts billable, accounts receivable, registration staff, etc. to continuously improve processes for patient charge identification.\\r\\n\\tAssist with monthly claim denial review.\\r\\n\\tWork coding claim edits.\\r\\n\\tReview CCI edits and documentation to determine if modifiers are appropriate\\r\\n\\tReview claims edits for medical necessity.&nbsp; Review documentation for supporting diagnosis codes.\\r\\n\\tReview claim edits for MUE&rsquo;s (Medically Unlikely Edits) and determine appropriate correction.\\r\\n\\tReview claim edits to determine if claim should be sent to different department queues.\\r\\n\\tCompile user friendly Denials Management Report from Qlik Denials Management Report to aid in determining true, preventable denials that we could be placed into an action plan to decrease such denials.\\r\\n\\tBuild and maintain a shared folder of payer policies for coding and medical necessity to aid in decreasing claim edits and denials based on these policies ICD-10 and CPT/HCPCS coding.\\r\\n\\tReview pending clinic accounts for complete documentation, signatures, etc.\\r\\n\\tAny other assigned duties.\\r\\n\\r\\n\\r\\nKNOWLEDGE/SKILL/ABILITIES: Previous patient billing and patient record review with preferred coding experience.\\r\\n\\r\\nAGE-RELATED COMPETENCIES: Demonstrates the basic knowledge and skills necessary to identify age-specific patient needs appropriate for this position.\\r\\n\\r\\nInformation Management: Treats all information and data within the scope of the position while maintaining patient confidentiality and security. Complies with HIPAA and compliance guidelines established by Artesia General Hospital.\\r\\n\\r\\nRisk Management/Quality Management/Safety: Cooperates fully in all Risk Management, Quality Management, and Safety Activities and Investigations.\\r\\n\\r\\n&nbsp;\\r\\n\",\"employmentType\":\"FULL_TIME\",\"hiringOrganization\":{\"@type\":\"Organization\",\"name\":\"Artesia General Hospital\",\"logo\":\"https://www.paycomonline.net/v4/ats/web.php/application/style/logo?clientkey=704B7D084ED420D91018B0DB07C889BE\"},\"qualifications\":\"\\r\\n\\tEducation &ndash; High School Diploma\\r\\n\\tWork Experience &ndash; Billing &amp; Coding knowledge preferred.\\r\\n\\r\\n\\r\\nENVIROMENTAL CONDITIONS: Remote home conditions.\\r\\n\\r\\n&nbsp;\\r\\n\",\"experienceRequirements\":\"\\r\\n\\tEducation &ndash; High School Diploma\\r\\n\\tWork Experience &ndash; Billing &amp; Coding knowledge preferred.\\r\\n\\r\\n\\r\\nENVIROMENTAL CONDITIONS: Remote home conditions.\\r\\n\\r\\n&nbsp;\\r\\n\",\"industry\":\"Business Office\",\"validThrough\":\"2027-01-06\",\"workHours\":\"Day\",\"educationRequirements\":\"High School Diploma / GED\"}",
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