Major Responsibilities:
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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.
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Performs remediation of charge errors discovered during EPIC review.
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Identifies appropriate use of billing modifiers and other CMS requirements for billing research-related charges to federal and non-federal payors.
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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.
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Remains knowledgeable about CMS and Fiscal Intermediary medical necessity guidelines and their impact on billing and reimbursement in clinical research.
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Collaborates with the clinical research department administrators and study coordinators in the development and implementation of educational activities related to charge capture improvement projects.
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Supply all missing information and correct inaccurate data as needed.
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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.
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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.
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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.
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Perform specialized duties involved in the preparation and processing of particularly complex charge issues.
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Audit and review accounts to ensure accuracy; investigate and correct errors, follow-up on missing account information, and resolve past due accounts.
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Identify insurance issues that need to be forwarded and addressed by the appropriate insurance teams. Report issues to the appropriate supervisor as needed.
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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.
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Demonstrates responsibility for personal development by participating in continuing education offerings.
Licensure, Registration, and/or Certification Required:
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None Required.
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Epic certification is helpful
Education Required:
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Bachelor's Degree preferred
Experience Required:
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Minimum of 2-3 years related coding/reimbursement experience required.
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Medical terminology, knowledge of accounts payable and receivable processes preferred.
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Minimum of 3 years Business Office experience in a healthcare environment or Research Office experience, Experience with Research Compliance preferred.
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Billing or Coding experience preferred.
Knowledge, Skills & Abilities Required:Physical Requirements and Working Conditions:
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Excellent oral and written communication skills. Excellent phone etiquette and internal/external customer service skills, required.
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Strong interpersonal skills and attention to detail.
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Experience with computerized databases (e.g., Microsoft Excel), word processing (e.g., Microsoft Word), and presentation software (e.g., Microsoft PowerPoint).
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Demonstrates ability to work independently.
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Strong attention to detail
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Ability to retain large amounts of information to perform in a timely and efficient manner
Remote position, candidate must be located in one of the following states: AL, AK, AR, AZ, DE, FL, GA, IA, IS, IL, IN, LA, KS, ME, MI, MO, MS, MT, NC, ND, NE, HH, NM, NV, OH, OK, PA, SC, SD, TN, TX, UT, VA, WV, WY
This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.