Company :Allegheny Health NetworkJob Description : 

GENERAL OVERVIEW:

This job is responsible for working accounts from work queues; activities include analysis (including root cause), monitoring & auditing payer issues and denials, appealing RAC audits and reports that require well-developed analytic and organizational skills, while meeting deadlines. Working under the close cooperation with others in the department to communicate and/or enhance work flows and procedures by identifying training and development needs based on audit or workqueue trends.             

ESSENTIAL RESPONSIBILITIES

Reviews, analyzes and resolves accounts that have failed coding and charging related claim edits, including medical necessity, National Correct Coding Initiative (NCCI), Medicare Outpatient Code Editor (OCE), Medically Unnecessary Edits (MUE), and other exceptions requiring clinical/coding expertise. Works to resolve rejections and accounts flagged for potential missing charges. (50%)Completes payor audits. Researches and evaluates government regulations and third party payor requirements to ensure accurate error resolution and appropriate billing. (30%)Daily assessment of blood bank report and reconciliation, and supply chain for mapping and charge validation. (20%)Working with other department members on establishment of work plans to correct identified deficiencies,  providing guidance, communication and education on correct charge capture, coding and billing processes. (10%)Other duties as assigned.

QUALIFICATIONS:

Minimum

High School/GED1 years of hospital or physician revenue cycle, billing, or coding experience

Preferred

Associate's Degree

Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.
 

As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times.  In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy. 

Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, age, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, age, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability. 

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