Facility

Cape Fear Valley Medical Center

Location

Fayetteville, North Carolina

Department

PFS Training

Job Family

Clerical

Work Shift

Days (United States of America)

Summary

Provide quality review and continuous improvement of accounts. Accountable for monitoring the adherence to policy and procedures for the departments, ensuring the appropriate number of accounts are monitored, audited, and reviewed. This role will focus primarily on auditing of accounts.

Major Job Functions

The following is a summary of the major essential functions of this job.  The incumbent may perform other duties, both major and minor, that are not mentioned below.  In addition, specific functions may change from time to time:

• Work Epic workqueues for Medicare accounts and monitor accuracy of Medicare accounts

• Conduct audits of Medicare Secondary Payer Questionnaire ensuring accuracy prior to billing

• Conduct audits of accounts for accurate registration information including demographic information, employers, patient contacts, PCP, guarantor, claim information, insurance coverage and completion of registration forms

• Annotate errors, make corrections or send errors to employee and their supervisor ensuring timely processing of claims

• Methodically track errors for training opportunities and notify manager of any trends

• Utilize payer websites or place calls to payer to verify insurance coverage if RTE is unable to provide eligibility information

• Maintain patient confidentiality and privacy by accessing patient information only to the extent necessary to fulfill assigned duties; patient information must be kept private, confidential, and secure; all lists, reports, files, and documents must always be properly secured and stored

• Document accounts with QA information to ensure HIPAA compliance

• Partner with Revenue Cycle trainers to identify proactive changes to update and maintain appropriate training content

• Maintain accurate notes and electronic documentation of findings; document requirements, expectations and/or deadlines to ensure accurate and timely completion of tasks

• Meet productivity standards designated by management with minimal errors

• Comply with all required policies, regulations, and procedures applicable to the learning process

• Participate in special projects as needed

• Other duties as assigned

Minimum Qualifications

The following qualifications, or equivalents, are the minimum requirements necessary to perform the essential functions of this job:

Education and Formal Training: 

• High school diploma or equivalent required

• Associate’s degree preferred

Work Experience: 

• 2 years experience in revenue cycle, healthcare industry, patient access or billing required

• 1 year Epic experience preferred

• 1 year experience with QA monitoring preferred

Knowledge, Skills, and Abilities Required: 

• Excellent interpersonal skills, verbal, and written communication skills

• Strong knowledge of compliance needs related to HIPAA privacy rules, CMS claim submission rules and other standard regulatory guidelines for hospital billing

• Knowledge of insurance preferred

• Ability to function independently and prioritize work within established policies

• Highly organized and possess excellent time management skills

• Strong attention to details

• Excellent analytical and critical thinking skills

Physical Requirements: 

• Ability to communicate orally, see and hear to collect information

• Subject to eyestrain due to the many hours spent looking at a computer screen

• Long periods of sitting

• Noise level is low to moderate

Required Licenses and Certifications

Cape Fear Valley Health System is an Equal Opportunity Employer M/F/Disability/Veteran/Sexual Orientation/Gender Identity