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Under minimal supervision, this position is responsible for the Henry Ford Health System's (HFHS) transaction flow processes, including the use of coding knowledge to effectively design insurance recovery and patient pay workflows, research and identification of root causes resulting in edits and denials, and assisting with developing error prevention initiatives and coordination with HFHS business units and internal customers.
PRINCIPAL DUTIES AND RESPONSIBILITIES:
1. Participates in the design and continuous evaluation of insurance follow up and recovery functions and workflow, to organize work based on production action to achieve optimal efficiency and productivity. 2. Work in partnership with staff of the Insurance Follow Up and Recovery department to identify opportunities for improvement and implement changes.
3. Work in partnership with Helios management and staff to identify, design, test, implement, and monitor changes to the Epic HB and PB systems.
4. Researches specific types of errors, including DNB's, claim edits, and payer denials to identify the root cause of error and identifies opportunities for prevention.
5. Uses routine and ad hoc analytics and reporting to support identification and investigation of errors, trends, and performance monitoring.
6. Participates in denial management infrastructure with constant focus on identifying root causes and developing prevention initiatives.
7. Participates in departmental and cross-functional workgroups to implement initiatives to reduce denials and other errors. This includes coordination with other HFHS business units, Corporate Revenue Cycle, hospital departments, physician practices, and other teams across the organization.
8. Work in partnership with staff of the Patient Pay and Pricing department management and staff to identify opportunities for improvement and implement changes.
9. Participates in the development and implementation of compliance and quality monitors for the CBO.
10. Assists in the creation and implementation of training for new and existing billing staff on applicable operating policies, protocols, systems related to the CBO, procedures, standards, and techniques. 11.Understands and remains updated with current coding, billing and compliance requirements and distribute the information within the CBO. Participates with work groups to develop and implement necessary policies and procedures to account for the payer rule changes.
12. Expert knowledge with EPIC billing processes and functionality to assist with research, testing, and identification of process improvement opportunities.
13.Supports the standards set forth in the HFHS Code of Conducts by creating an atmosphere of commitment to legal and ethical standards.
14.Actively participates in various committees.
EDUCATION/EXPERIENCE REQUIRED:
- High school degree or equivalent.
- Associate's degree or equivalent years of college education, preferred.
- Two (2) years of coding experience.
- Experience with denial management.
- Experience with both technical (UB) and professional (1500) billing, preferred.
- Experience with billing and follow up of variety of insurance payers, preferred.
- Experience at a large, complex, integrated healthcare organization, preferred.
- Experience with patient billing, patient accounting and other related applications, preferred.
- Experience with EPIC Patient Accounting System, preferred.
- Ability to communicate effectively with colleagues, supervisors, and managers.
- Strong organizational and time management skills required to effectively prioritize workflow to meet third party requirements.
- Ability to work independently. Ability to understand and lead change.
- Knowledge of Medical terminology, preferred.
- Ability to analyze data and identify opportunities.
CERTIFICATIONS/LICENSURES REQUIRED:
- Coding certification required such as CPC, CPC-A, CCS, CCP, CCA, or RHIT.
Equal Employment Opportunity/Affirmative Action Employer
Equal Employment Opportunity / Affirmative Action Employer Henry Ford Health System is committed to the hiring, advancement and fair treatment of all individuals without regard to race, color, creed, religion, age, sex, national origin, disability, veteran status, size, height, weight, marital status, family status, gender identity, sexual orientation, and genetic information, or any other protected status in accordance with applicable federal and state laws.