Research Billing Reviewer

Advocate Aurora Health; Winston-Salem (NC); Remote; USD 60,000 - 80,000; Full time

Job summary

A healthcare organization in Winston-Salem is looking for a full-time individual to review technical and professional charges in a remote setting. The ideal candidate will have at least a High School Diploma with preferred coding or reimbursement experience. Strong communication and customer service skills are crucial. This position offers a pay range of $22.50 - $33.75 per hour, along with comprehensive benefits and development programs.

Benefits

Paid Time Off

Health and welfare benefits

Flexible Spending Accounts

Educational Assistance Program

Qualifications

• Minimum of 1-year related coding/reimbursement experience preferred.
• Minimum of 1-year business office experience in a healthcare environment or Research Office experience preferred.

Responsibilities

• Review technical and professional charges for accuracy.
• Remediate charge errors discovered during review.
• Identify appropriate use of billing modifiers.
• Verify and resolve discrepancies using available tools.
• Collaborate on educational activities related to charge capture improvement.
• Audit and review accounts for accuracy.

Skills

Excellent oral and written communication skills

Attention to detail

Customer service skills

Interpersonal skills

Experience with Microsoft Excel

Experience with Microsoft Word

Experience with Microsoft PowerPoint

Ability to work independently

Education

High School Diploma or GED

Associates Degree

CPC or RHIT certification

Job description

Department

85203 Wake Forest University Health Sciences - Academic Office of Clinical Research

Status

Full time

Benefits Eligible

Yes

Hours Per Week

40

Schedule Details / Additional Information

Remote Position. 8:00am - 5:00pm

Pay Range

$22.50 - $33.75

Education / Experience

High School Diploma or GED required; Associates Degree preferred. Minimum of 1-year related coding/reimbursement experience preferred. Medical terminology, knowledge of accounts payable and receivable processes preferred. Minimum of 1-year business office experience in a healthcare environment or Research Office experience preferred.

Licensure, Certification, and/or Registration

CPC or RHIT certification preferred.

Essential Functions

• 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. Responsible for the movement of funds and correction of fees in EPIC.
• 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.
• Performs other related duties, as assigned.

Skills / Qualifications

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.

Work Environment

Clean, comfortable, well-lit, office environment.

Our Commitment to You

Advocate Health offers a comprehensive suite of Total Rewards: benefits and well-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more – so you can live fully at and away from work, including:

Compensation

• Base compensation listed within the listed pay range based on factors such as qualifications, skills, relevant experience, and/or training
• Premium pay such as shift, on call, and more based on a teammate's job
• Incentive pay for select positions
• Opportunity for annual increases based on performance

Benefits and more

• Paid Time Off programs
• Health and welfare benefits such as medical, dental, vision, life, andShort- and Long-Term Disability
• Flexible Spending Accounts for eligible health care and dependent care expenses
• Family benefits such as adoption assistance and paid parental leave
• Defined contribution retirement plans with employer match and other financial wellness programs
• Educational Assistance Program