Medical Claims - Charge Auditor

Description of position & purpose

Responsible for working/editing daily assigned claims, optimizing timely transmittal of accurate and clean claims. The nurse auditor/analyst is responsible for identifying and obtaining invalid/missing claim data by communicating with other departments to secure and/or correct the data which prevents claim submission. Protects payor deadline by utilizing all available resources to resolve held claims and assures all known regulatory and compliance guidelines are adhered to.

Analyze and resolve patient claims being held by billing edits. Review the APCGrouper, Ancillary, Overlap and Rapid Response reports/worklist daily for timely resolution of billing edits.Acts as a liaison and interacts with departments to obtain information needed to properly bill accounts based on the documentation in the medical record.Prepares and reviews work comp implant invoices to ensure accurate billing.Assist with late charge action plan templates.

Qualifications

3-5 years prior experience in billing of claimsUnderstanding of all required fields on the UB-04, correct coding initiative,revenue codes, DRG guidelines, ICD-10, CPTs and HCPCs, modifiers, condition codesStrong working knowledge of third-party billing requirements to include Medicare, Medicaid, Commercial and Managed Care payers.