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The Charge Management Analyst will perform internal quality assessment claim reviews to ensure compliance with federal, payer and internal Revenue Cycle policies. The position works in coordination with all hospital departments to improve the accuracy, integrity and quality of patient charges and to ensure minimal variation in charging practices. Will respond to requests to research and provide resolution for claim data variances, evaluate payer updates and assist in the performance of audits to produce and maintain timely, accurate and inclusive charge capture coding and billing functions. Works to identify charge issues and recommend solutions.

EDUCATION, CREDENTIALS, TRAINING and EXPERIENCE:

Current coding certification as a RHIA, RHIT, Certified Professional Coder (CPC), Certified Outpatient Coder (COC), or Certified Coding Specialist (CCS) or a minimum of 3 years coding experience.

Preferred:

Proficiency with Epic clinical documentation and hospital billing systems

Utilization management, medical review/audits, and denial/appeals experience

ADDITIONAL SPECIALIZED KNOWLEDGE/SKILLS/REQUIREMENTS:

• Knowledge of Medicare and Medicaid regulations including billing, coding and documentation requirements.
• Knowledge, understanding, and proper application of:
  • Medicare, Medicaid, and third-party payer billing and reporting requirements
  • UB-04 revenue codes
  • Medical billing modifiers
  • CPT/HCPCS coding including Medicaid specific requirements
  • NCCI/OPPS CPT/HCPCS coding edits (CCI/OCE)
  • Medically Unlikely Edits (MUE)
  • Medicare advance beneficiary notice (ABN) reporting guidelines
  • Medicare and other third-party payer published medical necessity edits
  • Local Coverage Determination (LCD) policies
  • ICD-10 coding system
  • APC classification system
  • Medical terminology

• Competent in the use of Electronic Medical Record and Billing Systems
• Strong verbal, written and interpersonal communication skills
• Ability to produce accurate, assigned work product within specified time frames
• Understanding of multiple reimbursement systems including IPPS, OPPS, APC, and fee schedules
• Proficient in using Microsoft applications which include Outlook, Excel, Word, PowerPoint and other web-based applications

• Ability to research, analyze and interpret healthcare policies, billing guidelines, and state and federal regulations