Capital Regional is a 266-bed acute-care hospital that offers 24/7 Emergency Services in Leon and Gadsden Counties including; a Pediatric ER, Senior Care ER and an Express Care ER. Offerings also include a Bariatric Center, Behavioral Health Center, Cancer Center, Chest Pain Center w/PCI, Comprehensive Breast Center, Family Center, Heart & Vascular Center, Orthopedic Center, Physical Therapy Services, Seniors First, Sleep Center, Stroke Center, Surgical Services, Wound Healing Center, Network-of-Care Affiliated Physician Practices, and more.
Responsible for ensuring all charge entry, coding, and reimbursement activities, including securing, maintaining and distributing the most current coding information and implementing changes.
1. Develop and implement a plan to optimize the current practice's billing process in order to maximize revenue.
2. Ensures all cancer center staff and physicians are updated on most recent billing and coding requirements.
3. Routinely reviews local, state, and federal requirements for medical and radiation oncology billing and educates staff to the most accurate procedures.
4. Obtains all appropriate information necessary to perceptively screen patients, obtain all relevant medical data, and provide direction and other information to patients.
5. Oversees front office staff in the pre-certification of patients. Oversees the contacting of insurance companies, referring physicians, etc., and obtaining certification to provide services to the patient.
6. Oversees the process for determining co-payments and works with front office staff for collection.
7. Oversees the posting of payments and closes out front office staff drawers.
8. Ensures correct coding is accumulated throughout the process of patient visit and treatment prior to being entered into the information system. Makes appropriate changes and educates personnel on the appropriate utilization of codes.
9. Reviews all accumulated charges prior to being entered into the system/entering charges.
10. Reviews and verifies insurance claims.
11. Follows up with insurance companies and ensures payments are received for services rendered by appropriately following up with the insurance companies.
12. Participates and oversees the resubmission of insurance claims that have been rejected and/or denied, with appropriate information.
13. Utilizes physician prescription and treatment plan in conjunction with insurance verification, to determine insurance and patient responsibility. Reviews all information with patients and assists with making payment plans.
14. Manages the credentialing of providers, payers, and entities related to practice, to include CRCC.
15. Conduct monthly chart audits to ensure new processes are being implemented appropriately and help identify new areas of improvement.
16. Daily Collection, verification and charge entry or interface of radiation oncology services.
17. Verifies that charges cross over to HOST and that data is accurate.
18. Performs checks of the data transfers, CCI edits, valid account information, insurance clearance and account status.
19. Prepares charge capture summary form for all treatment patients. Performs chart "close" at the end of treatment to insure that all charges are documented and billed correctly.
20. Assists with random sampling audits when requested.
21. Insures that documentation, procedures and charge processing meet standards.
22. Reviews diagnosis coding to insure that billed services reflect the site specific diagnosis.
23. Reconciles charges / issues that appear on PAS reports for assigned center. Checks reports and requests on a daily basis and communicates any issue that may impact the timely billing of charges.
24. Communicates issues related to the revenue cycle such as; missed charges, new procedures, etc. to insure that opportunities for improvement are initiated.
25. Submits and verifies procedure code adjustments (L-Lines and C-Lines) required to correct billing of accounts. Advises Director/Manager and Regional Director of negative or erroneous charging trends.
26. Addresses any CPT/HCPCS code or revenue issues, unbilled accounts, or industrial accounts that require attention.
27. Monitors the center's schedule for new treatment accounts, changes to patient status or payer and unexpected treatment stops. Tracks completed and closed courses to "close" the record within one week of the last treatment.
28. Works directly with registration / front office staff to insure that coverage for patients currently on treatment has been re-authorized.
29. Monitors patient status to insure that SNF, Rehab or other IP facility billing is authorized and appropriate.
30. Evaluation & Management service charges processed within one week of service with special attention to the last day of the month. Works directly with the front office staff to insure that all services authorized and that the coding is accurate.
31. Provides back up to the front office with eRequests, co-payment identification and collections, insurance verification, chart preparation, scanning documents into OnBase, etc.
32. Establishes and maintains positive relationships with physicians and co-workers, communicates effectively with all staff by responding promptly to insurance clearance requests.
33. Performs financial counseling when requested. Prepares estimates for treatment and submits to select payers. Tracks self pay or uninsured accounts for Medicaid approval. Insures that Meditech is updated once Medicaid is approved and notifies Manager / Director.
34. Other duties as requested or required.
EDUCATION REQUIRED AND/OR PREFERRED:
High School Graduate or GED
EXPERIENCE REQUIRED OR PREFERRED:
2-3 Years Radiation Oncology billing and coding experience
SKILLS, KNOWLEDGE, AND ABILITIES:
• Knowledge of Meditech, HOST, DET, and OnBase preferred.
• Knowledge of insurance verification processes and authorization procedures.
• Knowledge of medical office procedures to include cash collection and posting.
• Knowledge of CPT and Diagnosis coding.
• Effective organizational and customer service skills.
• Ability to communicate effectively, both verbal and written
• Ability to work well with others
• Ability to organize work independently and consistently achieve reporting deadlines
• Ability to interact with other individuals at all levels of management
A little about us:
HCA is the nation’s leading private provider of healthcare services. Comprised of locally managed facilities which include 230,000 employees at over 160 hospitals, over 120 surgery centers and 100 urgent care facilities in 20 states and the United Kingdom