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Clinical Billing Specialist
4 months ago
MISSION STATEMENT
The mission of The University of Texas M. D.
Anderson Cancer Center is to eliminate cancer in Texas, the nation, and the world through outstanding programs that integrate patient care, research and prevention, and through education for undergraduate and graduate students, trainees, professionals, employees and the public.
SUMMARY
The primary purpose of the Clinical Billing Specialist (CBS) position is to provide oversight of professional fee capture and process charges via electronic system (EPIC) and the Cube for the Department of Gastrointestinal Medical Oncology.
The ideal candidate must be able to use well-developed interpersonal and problem-solving skills, work independently, and handle complex issues in a large, diverse department.
JOB SPECIFIC COMPETENCIES
Charge Capture Reconciliation 80%
- Monitors all daily charge processes and entries for accuracy and timeliness, researches compliance issues, and coordinates compliance education while routinely providing recommendations to improve charge capture and documentation accuracy
- Develops, implements, and monitors reconciliation and audit processes to ensure all inpatient and outpatient professional and technical charges are appropriately captured within the department and provides reports of activities as required.
- Complete process mapping for professional charges capture
- Research documentation issues and provides recommendation for accurate documentation and compliance as appropriate
- Coordinates with revenue operations and coding for educational compliance, researches compliance issues, and provides recommendations to improve documentation accuracy
- Works with other departments/divisions to assure all billing and collection activities are optimized
- Demonstrate commitment to collaborative professional relationships with physicians, APRNs, Institutional Billing Compliance, Revenue Integrity, Coding Department, and all other persons relating to the duties and responsibilities of the CBS.
- Must be able to effectively communicate with providers, management, and other professionals who may be encountered during the resolution or suggestion of resolutions
- Stay abreast of the ever changing rules, regulations, and interpretations of the physician based billing in the outpatient and well as inpatient setting.
- Attend applicable trainings and updates provided by any relevant department
- Must be able to focus and follow through on many tasks at one time.
- Reconcile charges daily to identify possible missing charges and ensure accurate and timely charge submission for services rendered in assigned bill areas
- Appropriate reconciliation tools will be used daily, including charge reconciliation report(s), other clinical documentation tools and designated work queues to ensure professional charges for services rendered are compliant and documentation is in the EMR to support compliant billing.
- Daily reconciliation of other departmental professional charge capture.
- Communicate inaccuracies, provide resolution, and corrective action while working with multiple areas in collaboration with management for charges and revenue mapping.
- Maintains standardized workflows and productivity as designated by department management and institutional policies.
- Prepare departmental responses for institutional reports detailing lost opportunities for revenue.
- Maintain up-to-date information for department reporting.
- Provide real-time reports to department leadership and providers related to activity, trends, productivity, etc.
- Maintain up-to-date data for internal department spreadsheets tracking provider productivity.
- Identify trends and shifts in billing practices and researches/reports to leadership as appropriate.
- Prepares reports and makes recommendations to enhance revenue capture
- Prepare departmental responses for institutional reports detailing lost opportunities for revenue.
- Monitor Denials and identify trends and or common causes.
- Resolves denials by performing second review of medical records documentation and code assignment
Education Required - Associate's degree in Business Administration or related field.
Experience Required - Three years professional fee or technical billing experience in healthcare, insurance or related field. May substitute required education degree with additional years of professional billing experience on a one to one basis.
Preferred Experience:
Experience in coding/billing in a professional physician medical practice and/or an academic medical environment. Working knowledge and experience of CPT, HCPCS, state and local billing guidelines is a plus. Experience using Epic EMR is also a plus.
Onsite Presence:
Remote (In TX)
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.
