Research Charge Capture Specialist (Coding Specialist)
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Finance Department Overview:
Medical Center Finance is comprised of many areas, each of which has multiple diverse functions. Our various operational functions are continuously focused on supporting a strong internal control structure, providing oversight of hospital and clinical financial practices, supporting treasury and financial planning activities, overseeing our internal financial systems, and coordinating the necessary infrastructural support for each area. Financial improvements are supported through the strategic oversight of our reimbursement strategy, and implementation of our business process improvement efforts. Each area represents and contributes to the purpose of the Medical Center Finance department which serves as a strategic resource supporting the daily research, activities, and care provided by VUMC.
The Research Charge Capture Specialist position for the VUMC Department of Clinical Trials Billing Compliance will work directly with the Assistant Director of Clinical Trials Billing Compliance. The position will be responsible for performing line item charge review of research patient encounters in VUMC charge systems to assure the accuracy and completeness of charges captured for insurance and patient billing of inpatient and outpatient hospital services for research participants.
Performs review of technical and professional charges generated from ancillary subsystems to the research study account, insurance claim and/or patient statement to verify the accuracy of charges as they compare to the research billing intention/plan.
Performs remediation of charge errors discovered in MediPac/EPIC review via FACTr/Uber-StarBrite that correlate with documented medical/nursing interventions and differ from research billing intention/plan.
Identifies appropriate use of billing modifiers and other CMS requirements for billing research related charges to federal payors.
Verifies and resolves discrepancies by utilizing the tools and resources available, e.g. EPIC billing systems, medical record documentation, Charge Master data, Patient Accounting/VMG Business Offices and/or contacting 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 the clinical research department administrators in the development and implementation of educational activities related to charge capture improvement projects.
Required Experience and Skills
Knowledge and understanding of clinical research and clinical trials along with hospital revenue cycle operations (registration, charge capture, health information management, claims, payment posting).
Knowledge of regulatory publications, how to access and interpret.
Expertise as a certified medical coder with working knowledge of medical terminology.
Solid oral and written communication skills.
Experience abstracting from electronic medical records.
Excellent analytical and problem-solving skills.
Experience with Microsoft Office (Word, Excel, PowerPoint).
Preferred Experience and Skills
Candidates with advanced business or healthcare related degrees and professional work experience in revenue cycle operations and/or clinical operations, particularly Radiology, Cardiology, and/or Interventional Radiology/Cardiology).
Knowledge of government and commercial payer requirements to ensure accurate and compliant charging and billing of hospital inpatient, outpatient, surgical and ancillary services for research patient billing.
Knowledge of CPT, HCPCs, and revenue codes.
Working knowledge of clinical research study conduct and CMS regulations around appropriate clinical trials billing.
Working knowledge of VUMC or other major academic medical center clinical operations and related charge capture processes
Coding experience in a hospital inpatient and outpatient setting and professional certification as a RHIA, RHIT, CPC, CCS.
Proficient User of Business Objects, Medipac, Subject Tracker, FACTr, Uber/StarBrite and EPIC.