Failed Claims Specialist

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Job Description Summary:

This position is responsible for all Failed Claims processes for inpatient and outpatient encounters for Marion General so financial organizational goals are met. This individual will analyze IP and OP claims with problems that are holding the claims from billing, investigate these problems, recognize the issue, make necessary corrections and release the bill for payment. The position includes responsibility for coordination of data collection efforts with other primary users such as Patient Accounts and HIM. This position provides support to the Clinical Departments as necessary regarding claims and charge processing and development of educational material and presentation of seminars to other departments regarding prevention of Failed Claims.

Responsibilities And Duties:

50%
Identify claim issue, review charges for correctness, review edits and decide what needs to be done.
20%
Look up reports, review medical information in HBOC, code claim if has not been coded previously.
10%
Research OP and IP issues, coding issues, coder and/or regulatory questions via internet. CMS government regulations or transmittals/LMRP's, HCPCS codes, APC's, identify trends and provide education and feedback.
5%
Make corrections to claim add CPT and/or ICD- 9 procedure codes and or ICD- 9 diagnosis codes, modifiers, enter correct date of service, or cod complete record in HBOC and /or Chartstat t .
5%
Prepare and send spreadsheets to departments for charge adjustments.
10%
Review charts for other departments for charging and/or regulatory issues on IP and OP claims.

Minimum Qualifications:

High School or GED (Required)CCS - Certified Coding Specialist - American Health Information Management Association, CPCH - Certified Professional Coder - Hospital - AAPC American Academy of Professional Coders, RHIA - Registered Health Information Administrator - American Health Information Management Association, RHIT - Registered Health Information Technician - American Health Information Management Association

Additional Job Description:

Healthcare related professions. Certified as RHIA, RHIT, CCS or CPC.

Work Shift:

Day