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Work Shift

Day (United States of America)

Job Summary:

Responsible for first time billing of either governmental or non-governmental claims to third party payors. Capable of reviewing and troubleshooting claims within the billing system to correct errors, edits, or nuances preventing a bill from going to the payer.

Core Responsibilities and Essential Functions:

Authorizations, CMS and Payor Guidelines * Responsible for obtaining authorization for all Radiation Oncology CPT/Procedure codes for each patients case per diagnosis, medical necessity following government regulations and payor guidelines, including CMS NCD/LCDs. * Constant follow up with payors until authorization is obtained. Ensuring documentation available at payor request for authorization and reimbursement of claims. * Ongoing review of CMS, payor guidelines for updates. * Collaborating with the clinical team authorizing complex specialty procedure codes along with complex modalities. * Scheduling Peer to Peer communication between attending/ordering physician. Charge Capture: Posting, Accuracy and Auditing * Responsible for reviewing clinical documentation to ensure timely, accurate and compliant charge capture. * The individual works as an educational resource to inform and educate department on latest government regulations and requirements, including CMS, the State and payer regulations related to these charges. * Actively and effectively communicate with ancillary departments to resolve claim and charge issues to expedite bills to payers. * Performs daily, weekly and monthly charge capture audits and ensures that Radiation EMR matches Hospital Billing reports and corrects any discrepancies discovered. EPIC Work-queues * Maintains and corrects charge/billing review work-queues assigned by alpha or groupings which generates edits requiring billing intervention to create clean claims. Manages Payor Denials. * Denials-Reviews and Maintains Claim Denial WQs for authorization, medical necessity, and incorrect coding. * Maintains and appeals claims returned to the biller work-queue in EPIC that have been denied by the payor. Cross-Campus support, collaboration and denial processing. * Collaborates with other departments and cross-campus counterpart(s) to ensure clinical documentation in high-risk areas is consistent and complete. * The Radiation Billing Specialist collaborates with cross-campus counterpart(s) to ensure consistency in such a manner that everyone can act as a back-up for the other to ensure seamless charge capture in high-risk areas when an individual is out. * Duties include charge entry, ensuring correctness of coding in Charge Review, provide ongoing education to staff and works payer coding denials. Performs other duties as assigned Complies with all Wellstar Health System policies, standards of work, and code of conduct.

Required Minimum Education:

High school diploma equivalent from an accredited institution Bachelor's Degree

Required Minimum License(s) and Certification(s):

All certifications are required upon hire unless otherwise stated.

• CPC - Cert Prof Coder-Preferred
• ROCC - Radiation Oncology Cert Coder-Preferred

Additional License(s) and Certification(s):

Required Minimum Experience:

Minimum 1 year experience in insurance billing and collections in hospital or physician environment. Required

Required Minimum Skills:

Ability to perform mathematical calculations and comfortable with keyboard by touch. Excellent communication skills when dealing with patients, families, public, co-workers and professional offices. Experience in Excel and Word. Demonstrates a general knowledge of medical terminology, ICD9-CM, ICD10-CM, and CPT procedure codes relative to hospital practices. Competent written and oral communication skills, time management organization, and an attention to detail. Displays strong knowledge of analytical and problem-solving skills.

Join us and discover the support to do more meaningful work—and enjoy a more rewarding life. Connect with the most integrated health system in Georgia, and start a future that gives you more.