What are the responsibilities and job description for the CLAIMS EDITOR position at Elliot Health System?
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POSITION SUMMARY
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This position supports all activities related to Federal, State funded and commercial code based reimbursement to ensure that the hospital is in compliance with federal regulations and that reimbursement is both timely and accurate. Reviews and monitors all charges entered by departments into the electronic medical record for quality and appropriateness. Functions as liaison between departments, coders and billers for all charge issues.
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PRIMARY DUTIES AND RESPONSIBILITIES
Employees are expected to work consistently to demonstrate the mission, vision, beliefs, core values and standards of behavior of the organization.
- Responsible for monitoring all government related coding and billing practices, including NCD, LCD/LMRP, OCE and CCI edit management.
- Serves as a liaison to clinical departments to ensure that all edits are appropriately resolved.
- Reviews claims to ensure coding is accurate and in compliance with clean claim edits, within the designated timeframe.
- Apply compliant coding/billing practices to resolve claim edits.
- Performs dual maintenance (making corrections in Epic to coding and charging) as well as in MedAssets to resolve all claim edits.
- Develops and maintains reports which summarize and trend information.
- Works with departments as needed to prevent charge issues.
- Acts as a resource for coders.
- Reports to Coding Manager on progress of identified process improvements.
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POSITION QUALIFICATIONS
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Education:
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Minimally Required:
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High school diploma or equivalent required. Associate's degree in related field preferred
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Preferred:
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Licensure/certification:
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Minimally Required:
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Certified coding credentials - CPC, CPC - H, CCS, CCS-P, RHIT, or RHIA required.
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Preferred:
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Experience:
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Minimally Required:
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At least three (3) years of acute care coding experience with knowledge of charge description master and payer billing guidelines required.
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Preferred:
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Experience with Electronic Health Record (EHR), Microsoft Office and MedAssets preferred
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Knowledge:
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Minimally Required:
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Thorough knowledge of ICD-9-CM, CPT-4, DRG methodologies and all regulatory requirements associated with coding and DRG assignment.
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Must have knowledge of CMS guidelines.
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Knowledge of revenue cycle and reimbursement.
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Preferred:
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Skills:
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Minimally Required:
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Excellent communication skills, both written and oral, in order to communicate effectively with staff, physicians, and other hospital personnel.
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Excellent analytical skills for trending and analysis.
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Preferred:
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Abilities:
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Minimally Required:
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Ability to work independently and take initiative, good judgement and problem solving skills.
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Ability to develop relationships and collaborate with facility ancillary department management and revenue cycle teams to improve claims processes.
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Preferred:
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