Physician Practice Specialist

At ScionHealth , we empower our caregivers to do what they do best. We value every voice by caring deeply for every patient and each other. We show courage by running toward the challenge and we lean into new ideas by embracing curiosity and question asking. Together, we create our culture by living our values in our day-to-day interactions with our patients and teammates.

Job Summary

• The Physician Practice Specialist assists in resolving billing edits that are holding patient claims from Billing, by reviewing medical records and other applicable documentation
• This individual will improve the accuracy, integrity and quality of patient charges and will ensure minimal variation in charging practices
• The Physician Practice Specialist will coordinate all retrospective, concurrent, patient complaint and external billing audits

Essential Functions

• Requires critical thinking skills, decisive judgment, and the ability to work with minimal supervision
• Must be able to work in a stressful environment and take appropriate action
• Working knowledge of precertification and authorizations
• Exhibits expertise in editing claims for errors and communicating these corrections by eRequest to Parallon
• Balances, reconciles, and approves the daily deposit for Parallon
• Effectively explain charges and demonstrates the ability to answer questions concerning patient accounts
• Interacts in a positive and professional manner with patients/customers and co-workers
• Ensures the Charge Batch Report is worked and any rejects are corrected in a timely manner.
• Analyzing and resolving patient claims being held by billing edits on the Bill 45, Bill 49, CRT Medical necessity, Correct Coding Initiative, Outpatient code Editor (OCE), Inpatient Code Editor, Self-Administered and other claims requiring clinical expertise’s
• Interact with ancillary departments to obtain additional information needed to properly bill the account based on medical record documentation
• Identify charging, coding, or clinical documentation issues and work with ancillary departments to resolve those issues and notify appropriate leadership
• Serves as a charge master liaison to include regular reviews of CPT codes, Revenue Codes, reviews of monthly standard CDM error report and communicating with Ancillary departments to resolve issues
• Responsible for maintaining the Physician Master and the Insurance Master file
• Responsible for any charge error corrections
• Manages CRNA billing for both the hospital BCBS in State plans and off-site billing company
• Manages the PLUS report for staff volume
• Manages and completes all Industrial billing and follow-up
• Manages and assists ancillary departments with the Charge Audit Tool
• Responsible for adding Emergency Room Procedure charges
• Responsible for completion of the Skilled Nursing and Swing bed logs
• Responsible for exhibits 3, 4, 5, and 8 in the Standard Monthly Accrual (SMA) tool
• Responsible for balancing the Sleep Lab invoice
• Responsible for special projects and plays and key role in RAC and audits
• Displays appropriate office ethics and behavior with regard to interactions with customers, employees, and management. This includes handling conflicts and concerns in a timely and professional manner and utilizing crisis-de-escalation skills when appropriate
• Displays professionalism while completing multiple urgent tasks in a timely manner
• Functions as a preceptor or an educational resource in the initial and on-going orientation of new personnel, students, etc.
• Respects and honors cultural and religious differences between patients and self
• Responsible for SOX Charge Audits
• Other duties as requested

Education

• High School Diploma or equivalent – Required
• Associate degree – Preferred

Licenses/Certifications

• Certified Revenue Integrity Professional Certification – Preferred

Experience

• 1+ year Medical Coding – Required
• Experience with various payer types - Required