Reports Team Specialist

General Description:

Under general supervision, the Reports Team Specialist is responsible for reviewing accounts in multiple databases to determine the appropriateness of charges by reviewing the medical record, facility protocol and other applicable documentation. This review includes the verification of billing data for accuracy and completeness, following regulatory requirements, to resolve edits or exceptions detected during system processing of the claim in Patient Accounting, Relay Health or the payer. Applies modifiers when appropriate based on this review, and/or makes necessary adjustments to patient account charges and/or balances. Analyzes accounts for specialized billing requirements that require a review of the medical record documentation, regulatory information, and OUH.

Essential Responsibilities:

Responsibilities listed in this section are core to the position. Inability to perform these responsibilities with or without an accommodation may result in disqualification from the position.

• Analyzes and resolves specific billing edits that are delaying claims from processing in the Patient Accounting and/or Relay Health systems. This includes the verification (and/or correction) of billing data for accuracy and completeness, by following regulatory requirements, and reviewing the medical record, facility protocol, and other applicable documentation. This also includes the application of modifiers and condition codes, as appropriate.
• Responsible for managing Patient Accounting edits, rejections, and pre-denials by analyzing and resolving any issues on accounts with claim edit errors or processing issues that hit specific reports and workflow tools (i.e., BILL09, BILL45, BILL49PREA02, Red Flag, assigned eRequest queues, etc.).
• Responsible for working Patient Accounting interface transaction rejections in BatchNet daily.
• Manages unbilled claims/edits to ensure they are resolved within 3 days of edit origination to expedite claims payment.
• Resolves Payment Window edits by reviewing I-Plans for accuracy and creating Ref Lab accounts then routing them back to the appropriate department.
• Identifies root cause of rejections and provides root cause feedback to Revenue Cycle Leadership to prevent future rejections.
• Identifies and updates missing information in the computer system to resolve edits and prevent future claims from stopping or denying.
• Maintains required levels of productivity and quality while managing tasks to ensure timeliness of follow-up and resolution of edits.
• Handles information confidentially.
• Identifies charging, coding, or clinical documentation issues and works with appropriate leadership and ancillary departments to resolve issues identified while working on edits.
• Reviews Regulatory Compliance Communications. Assesses impacts to Revenue Integrity procedures and provides suggestions to Revenue Cycle Leadership to implement changes as needed.
• Makes necessary adjustments to patient account charges.

General Responsibilities:

• Performs other duties as assigned.

Minimum Qualifications:

Education: None required.

Experience: 1 year of health care billing or coding experience required.

OR equivalent combination of education and experience.

Licensure/Certifications/Registrations Required: None required.

Knowledge, Skills and Abilities:

• Analytical Skills - skills in data analysis, troubleshooting, and problem solving.
• Medical Coding - knowledge of hospital billing terminology and process.
• Communication - Communicates clearly and concisely, verbally and in writing. This includes utilizing proper punctuation, correct spelling, and the ability to transcribe accurately.
• Customer orientation - Establishes and maintains long-term customer relationships, building trust and respect by consistently meeting and exceeding expectations.
• Interpersonal skills - Must be able to work effectively with other employees, patients, and external departments. Ability to work independently, resourcefully, and creatively research and implement new solutions.
• PC skills - Demonstrates proficiency in Microsoft Office applications and others as required.
• Policies & Procedures - Demonstrates knowledge and understanding of organizational policies, procedures and systems.
• Basic skills - Demonstrates ability to organize, perform and track multiple tasks accurately in short timeframes. Must have ability to work quickly and accurately in a fast-paced environment while managing multiple demands. Must have ability to work both independently and collaboratively as a team player, adaptability, analytical and problem solving ability and attention to detail and able to perform basic mathematical calculations. Knowledge of billing rules and regulations