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Billing Compliance Analyst 8/16/2016

Methodist Houston, TX

Company
Methodist
Job Classification
Full Time
Company Ref #
25983
AJE Ref #
575891251
Location
Houston, TX
Experience
Mid-Career (2 - 15 years)
Job Type
Regular
Education
High School Diploma or GED

JOB DESCRIPTION

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Job Summary

1.Maintain a working knowledge on third party regulations with emphasis on Medicare coverage and billing, as well as hospital and professional fee billing requirements.

2.Document clear, concise and complete follow up notes in billing system for each patient account worked.

* Ability to work with various computer programs needed to perform assigned tasks such as EPIC, Velos, MORTI, Code Correct, and HIS/HPF.

4.Provide oversight of and perform detailed claims analysis and medical record review as necessary.



FINANCE - 20%

* Utilize Coverage Analysis (CA) or Billing Calendar to identify which charges need to be directed to the Study Account in EPIC (e.g., research study account).

* Verify accurate and concise claims are being billed to patients and third party payors.

* Have working knowledge of IDE billing process.

* Works with the Charge Master team to ensure cdms are built with the correct codes and modifiers for each study.



GROWTH/INNOVATION 10%

* Assist in performing annual risk assessment and development of audit plans.

* Audits and reconciles services and items included in the patient s chart with services and items included on the claim in a timely manner. Where exceptions are noted, suggested solutions are offered.

* Makes HM management aware of audit findings and helps develop plans to keep HM compliant with payor and government standards.





This job description is not intended to be all inclusive; the employee will also perform other reasonably related business/job duties as assigned. Houston Methodist reserves the right to revise job duties and responsibilities as the need arises.



EDUCATION REQUIREMENTS

High School Diploma; Preferably a Bachelor s Degree in Business Administration or Hospital Administration.



EXPERIENCE REQUIREMENTS

Minimum 5 years relevant experience in research billing and/or compliance.



CERTIFICATES, LICENSES AND REGISTRATIONS REQUIRED

Minimum of one professional coding certification (CPC, RHIA, RHIT or CHRC) or must be obtain within one year of employment



KNOWLEDGE, SKILLS AND ABILITIES REQUIRED

Please add additional knowledge, skills and abilities required to perform the essential functions.



* Working knowledge of clinical research billing, third party billing regulations with emphasis on CMS/Medicare rules.

* Strong analytical and interpersonal skills.

* Effective decision-making and team-building skills.

* Demonstrates effective oral and written communication skills, including the ability to maintain positive rapport with personnel at all levels and in all situations.

* Ability to work under pressure and balance many competing priorities.

* Ability to work with difficult people and in difficult situations.

* Ability to adapt to a rapidly changing environment and to adjust to new requirements.

* Applies sound judgment in applying and interpreting policies, procedures, laws, rules, and regulations applying to compliance and monitoring.

* Sufficient proficiency in speaking, reading, and writing the English language necessary to perform the essential functions of this job, especially with regard to activities impacting patient or employee safety or security.

* Ability to effectively communicate with patients, physicians, family members and co-workers in a manner consistent with a customer service focus and application of positive language principles.





PHYSICAL REQUIREMENTS

Activity Checklist attached (see below)



WORKING ENVIRONMENT



Normal office conditions and environment. Work hours are regular. Some travel required to various Methodist Hospital System locations.




Equal Employment Opportunity

Houston Methodist is an Equal Opportunity Employer.

Equal employment opportunity is a sound and just concept to which Houston Methodist is firmly bound. Houston Methodist will not engage in discrimination against or harassment of any person employed or seeking employment with Houston Methodist on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, status as a protected veteran or other characteristics protected by law.

VEVRAA Federal Contractor priority referral Protected Veterans requested.