BILLING QA COMPLIANCE SPEC

PHP Staging Mobile Taleo; Dayton (OH); On-site; USD 45,000 - 65,000; Full time

Job summary

Fidelity Health Care in Moraine, OH seeks a Billing QA Compliance Specialist to review inpatient and outpatient accounts for billing and coding compliance under the Patient Financial Services supervision.

You will monitor billing quality, verify documentation for billing accuracy, and follow up on outstanding accounts in the billing and follow-up queues. A high school diploma with 3–5 years in revenue cycle, plus knowledge of Medicare regulations and hospital billing, is preferred.

Qualifications

• High School diploma or GED required.
• Associate degree in Healthcare, Business Administration, or Health Information Management preferred.
• 3–5 years of revenue cycle experience.
• Demonstrated ability to train and educate to all levels of the organization.
• Knowledge of Medicare regulations related to charging and reimbursement preferred.
• Knowledge of hospital billing and follow up preferred.
• Familiar with medical terminology, pathology and DRG assignments.

Responsibilities

• Review inpatient and outpatient accounts for billing and coding compliance.
• Monitor quality of billing and verify documentation for billing information.
• Follow up on outstanding accounts in billing and follow up work queues.
• Understand reimbursement aspects of the revenue cycle and ensure proper reimbursement.
• Monitor timely billing and follow-up of clinical trial accounts if applicable.

Skills

MS Office

Education

High School Diploma / GED

Associate degree in Healthcare / Health Information Management / Business Administration

Job description

BILLING QA COMPLIANCE SPEC(

Job Number:

Description

General Summary/Responsibilities:

Under the general direction of the Supervisor Patient Financial Services this employee is responsible for the review of Inpatient and Outpatient accounts for billing and coding compliance for Patient Financial Services (PFS). He/she monitors for quality of billing, and reviews accounts for appropriate documentation to validate billing information. This employee is also responsible for follow up on outstanding assigned accounts in their billing and follow up work queues. All work is carried out in accordance with PFS approved policies and procedures. The specialist is also responsible for understanding reimbursement aspects of the revenue cycle and will work to ensure Premier Health receives the appropriate reimbursement for charges billed. The specialist is responsible for understanding governmental rules and regulations regarding chargeable verses payable, and the components of a compliance claim. Will monitor timely billing and follow-up of clinical trial accounts as a part of work queue audit reviews (if applicable to job duties).

Qualifications

++Education++

Minimum Level of Education Required:High School completion / GED

Additional requirements:

• Type of degree : High School Diploma with 3-5 years’ experience or Associate degree in Healthcare, Business Administration, Health Information Management

++Experience++

Minimum Level of Experience Required: 3 – 5 years of job related experience

Prior job title or occupational experience:Revenue Cycle Experience.

Prior specific functional responsibilities:Demonstrated working knowledge of Microsoft Office applications is required. Demonstrated ability to train and educate to all levels of the organization is required.

Preferred experience:Current knowledge of Medicare regulations as it relates to charging and reimbursement is highly preferred. Current knowledge of hospital billing and follow up is preferred. Knowledge of medical terminology knowledge of human pathology and diseases and how they relate to diagnosis and DRG assignments

Primary Location

: OHIO-MORAINE-Fidelity Health Care

Work Locations

:
Fidelity Health Care
3170 KETTERING BLVD
MORAINE 45439-1924

Shift Hours : 7:00 am – 3:30p Shift Length : 8 Hour Shift Length Budgeted Hours (per pay) : 80