RI Charge Capture Spec

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Exemption Status:

Non-Exempt

Schedule Details:

Monday through Friday

Scheduled Hours:

7-3:30

Shift:

1 - Day Shift, 8 Hours (United States of America)

Hours:

40

Cost Center:

99940 - 5452 RI and Charge Capture

Union:

SHARE (State Healthcare and Research Employees)

This position may have a signing bonus available a member of the Recruitment Team will confirm eligibility during the interview process.

Everyone Is a Caregiver

At UMass Memorial Health, everyone is a caregiver – regardless of their title or responsibilities. Exceptional patient care, academic excellence and leading-edge research make UMass Memorial the premier health system of Central Massachusetts, and a place where we can help you build the career you deserve. We are more than 16,000 employees, working together as one health system in a relentless pursuit of healing for our patients, community and each other. And everyone, in their own unique way, plays an important part, every day.

I. Major Responsibilities:

Charge Review:
1. Reviews and resolves all assigned edits within prescribed timeframe.
2. Determines appropriate payor plan for some charges and indicates payor/plan on billing documents for data entry.
3. Determines appropriate CPT/HCPCS/ICD10 codes for some charges, e.g., immunizations and consults for surgery.
4. Indicates appropriate UMass Memorial Medical Group fees for charges when applicable.
5. Performs billing corrections as determined/reported on Third Party Claim Run Edit Work Queues and Epic Claim Edit Work Queues
6. Supports continuous system improvements by collaborating with PFRT/RI Specialists and Clinical Charge Capture Specialists for continued improvement.
7. Provides feedback for the root cause that the edits are triggering.
8. Identifies trending in edits to support physician training and education and/or creation of additional system logic/edits.

Manual Charge Entry:
1. Sorts charge documents according to common parameters (i.e., billing area, doctor, location, etc.) and maintains statistical controls over charges.
2. Indicates appropriate physician input codes for all services to be billed by billing area.
3. Researches all assigned incomplete charge documents
4. Logs batches out in Daily Control Log and/or process defined within the department.
5. Balances charges on encounter forms to the Daily Control Log and/or process defined within the department and prepares morning management reports when necessary.
6. Collaborates with clinical department to facilitate timely processing of downtime encounters.

Authorizations (Behavioral Health pod only):
1. Verifies insurance information and secures authorizations and process according to established steps.
2. Correct registration for patients with new or updated insurance.
3. Obtain treatment forms when necessary and process per individual payor requests.
4. Verify insurance for all charges utilizing payor websites or telephone for out of state payors.
5. Verify behavioral health benefits and update information in referral record.
6. Communicate with sites regarding CPT/ICD10 code discrepancies, high deductibles and treatment forms.

License/Certification/Education:

Required:
1. High School Diploma or equivalent.

Preferred:
1. Associate of Arts degree/Certificate in the medical field (i.e., Medical Assistant, Medical Coding, etc.)
2. Behavioral Health/Mental Health knowledge.

Experience/Skills:

Required:
1. Three (3) years of work experience related to professional billing and coding.
2. Knowledge of clinical operations, charge creation, processing and reconciliation in a healthcare environment.
3. Knowledge of industry standard coding and billing methodologies, including current CPT/HCPCS/ICD codes.
4. Knowledge of and experience with clinical and revenue cycle computer systems.
5. Strong computer skills (e.g., Microsoft Word, Excel, PowerPoint, Project, Visio).
6. Excellent communication skills including the ability to effectively summarize and convey difficult and detailed topics to senior leadership and build consensus around improvement initiatives.
7. Training in professional coding and billing (boot camp).

Required for BH:
1. Three (3) years of work experience related to Behavioral Health/Mental Health billing and coding.
2. Knowledge of third-party payors, copays, deductibles, and authorizations.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.

We’re striving to make respect a part of everything we do at UMass Memorial Health – for our patients, our community and each other. Our six Standards of Respect are: Acknowledge, Listen, Communicate, Be Responsive, Be a Team Player and Be Kind. If you share these Standards of Respect, we hope you will join our team and help us make respect our standard for everyone, every day.

As an equal opportunity and affirmative action employer, UMass Memorial Health recognizes the power of a diverse community and encourages applications from individuals with varied experiences, perspectives and backgrounds. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, national origin, age, disability, gender identity and expression, protected veteran status or other status protected by law.

If you are unable to submit an application because of incompatible assistive technology or a disability, please contact us at . We will make every effort to respond to your request for disability assistance as soon as possible.