Research billing reviewer

Department :

80009 Research - Clinical Research Billing & Systems

Status : Full time

Full time

Benefits Eligible : Hou rs Per Week :

Hou rs Per Week :

Schedule Details / Additional Information :

Remote position : 8am-5pm

Major Responsibilities :

• Performs review of all technical and professional charges generated from EPIC and any ancillary subsystems for allocation to the research study account, insurance claim and / or patient statement to verify the accuracy of charges as they compare to the research billing intention / plan outlined in the protocol Billing Grid.
• Performs remediation of charge errors discovered during EPIC review.
• Identifies appropriate use of billing modifiers and other CMS requirements for billing research-related charges to federal and non-federal payors.
• Verifies and resolves discrepancies by utilizing the tools and resources available, e.g., EPIC billing system, OnCore (clinical trial management system), medical record documentation, Charge Master data, Patient Accounting / VMG Business Offices and / or contacting study personnel in the appropriate internal department.
• Remains knowledgeable about CMS and Fiscal Intermediary medical necessity guidelines and their impact on billing and reimbursement in clinical research.
• Collaborates with the clinical research department administrators and study coordinators in the development and implementation of educational activities related to charge capture improvement projects.
• Supply all missing information and correct inaccurate data as needed.
• Processes charge related corrections / additions / removals in EPIC for both the hospital and physician billing to ensure organizational compliance with all state and federal regulations.
• Calculates and facilitates the refunding of inappropriate reimbursement in collaboration with WFBMC Financial Services.

• Follows established hospital and physician departmental guidelines and state and federal regulations to assure the most productive and compliant outcome when processing charge related corrections.
• Perform specialized duties involved in the preparation and processing of particularly complex charge issues.
• Audit and review accounts to ensure accuracy; investigate and correct errors, follow-up on missing account information, and resolve past due accounts.
• Identify insurance issues that need to be forwarded and addressed by the appropriate insurance teams. Report issues to the appropriate supervisor as needed.
• Prioritizes job tasks; demonstrates willingness to assist Manager / Director in the completion of special projects and daily task to support the Department’s productivity and efficiency.
• Demonstrates responsibility for personal development by participating in continuing education offerings.

Licensure, Registration, and / or Certification Required :

• None Required.
• Epic certification is helpful

Education Required :

Bachelor's Degree preferred

Experience Required :

• Minimum of 2-3 years related coding / reimbursement experience required.
• Medical terminology, knowledge of accounts payable and receivable processes preferred.
• Minimum of 3 years Business Office experience in a healthcare environment or Research Office experience, Experience with Research Compliance preferred.
• Billing or Coding experience preferred.

Knowledge, Skills & Abilities Required : Physical Requirements and Working Conditions :

• Excellent oral and written communication skills. Excellent phone etiquette and internal / external customer service skills, required.
• Strong interpersonal skills and attention to detail.
• Experience with computerized databases (e.g., Microsoft Excel), word processing (e.g., Microsoft Word), and presentation software (e.

g., Microsoft PowerPoint).

• Demonstrates ability to work independently.
• Strong attention to detail
• Ability to retain large amounts of information to perform in a timely and efficient manner

Remote position, candidate must be located in one of the following states : AL, AK, AR

Last updated : 2024-06-19