BILLING QA COMPLIANCE SPEC

General Summary/Responsibilities:

Under the general direction of the Supervisor Patient Financial Services this employee is responsible for the review of Inpatient and Outpatient accounts for billing and coding compliance for Patient Financial Services (PFS). He/she monitors for quality of billing, and reviews accounts for appropriate documentation to validate billing information. This employee is also responsible for follow up on outstanding assigned accounts in their billing and follow up work queues. All work is carried out in accordance with PFS approved policies and procedures. The specialist is also responsible for understanding reimbursement aspects of the revenue cycle and will work to ensure Premier Health receives the appropriate reimbursement for charges billed. The specialist is responsible for understanding governmental rules and regulations regarding chargeable verses payable, and the components of a compliance claim. Will monitor timely billing and follow-up of clinical trial accounts as a part of work queue audit reviews (if applicable to job duties).

Education

Minimum Level of Education Required: High School completion / GED                          

Additional requirements:

• Type of degree:  High School Diploma with 3-5 years’ experience or Associate degree in Healthcare, Business Administration, Health Information Management

Experience

Minimum Level of Experience Required: 3 - 5  years of job related experience

Prior job title or occupational experience: Revenue Cycle Experience.

Prior specific functional responsibilities: Demonstrated working knowledge of Microsoft Office applications is required. Demonstrated ability to train and educate to all levels of the organization is required.

Preferred experience: Current knowledge of Medicare regulations as it relates to charging and reimbursement is highly preferred. Current knowledge of hospital billing and follow up is preferred. Knowledge of medical terminology knowledge of human pathology and diseases and how they relate to diagnosis and DRG assignments