Billing Reviewer I - CTSI

Entry-level performer of charge capture and claim resolution in Epic (electronic health record and patient billing system) for clinical research studies across all regions of the Advocate Enterprise.

Responsibilities

• Performs line-item charge review of research patient encounters in the Advocate Health charge capture system, EPIC.
• Assures the accuracy and completeness of all assigned charges linked to research in EPIC and captured for study sponsor or insurance/patient billing of inpatient and outpatient hospital services for research participants.
• 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 accuracy as compared to the research billing intention/plan outlined in the protocol Billing Grid.
• Performs remediation of charge errors discovered during EPIC review.
• Identifies appropriate use of billing modifiers and other CMS requirements for billing research-related charges to federal and non-federal payors.
• Verifies and resolves discrepancies by utilizing available tools and resources (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.
• Remains knowledgeable about CMS and Fiscal Intermediary medical necessity guidelines and their impact on billing and reimbursement in clinical research.
• Collaborates with clinical research department administrators and study coordinators in the development and implementation of educational activities related to charge capture improvement projects.
• Supplies all missing information and corrects inaccurate data as needed.
• Processes charge-related corrections/additions/removals in EPIC for both hospital and physician billing to ensure organizational compliance with all state and federal regulations.
• 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.
• 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.
• Performs specialized duties involved in the preparation and processing of particularly complex charge issues.
• Audits and reviews accounts to ensure accuracy; investigates and corrects errors, follows up on missing account information, and resolves past due accounts.
• Identifies insurance issues that need to be forwarded and addressed by the appropriate insurance teams; reports issues to the appropriate supervisor as needed.
• Prioritizes job tasks; demonstrates willingness to assist Manager/Director in the completion of special projects and daily tasks to support the Department's productivity and efficiency.
• Demonstrates responsibility for personal development by participating in continuing education offerings.
• Performs other related duties, as assigned.

Requirements

• High School Diploma or GED required; Associate Degree preferred.
• Minimum of 1-year related coding/reimbursement experience preferred.
• Medical terminology, knowledge of accounts payable and receivable processes preferred.
• Minimum of 1-year business office experience in a healthcare environment or Research Office experience preferred.

Qualifications

• CPC or RHIT certification preferred.

Skills

• Excellent oral and written communication skills.
• Excellent phone etiquette and internal/external customer service skills.
• Strong interpersonal skills and attention to detail.
• Experience with computerized databases (e.g., Microsoft Excel), word processing (e.g., Microsoft Word), and presentation software (e.g., Microsoft PowerPoint).
• Demonstrates ability to work independently.