This position is responsible for data scrubbing, error corrections, and identifying/correcting processes and systems that lead to lost revenue opportunities and reduced reimbursement for the care provided to clients. It requires collaboration with clinicians, supervisors, MIS, financial and quality management staff to ensure appropriate and timely data scrubbing and error corrections occur in BHR's electronic health record system.
RESPONSIBLE TO: Director of Quality Management/MIS
High School Diploma or GED equivalent
Two (2) years' experience with demonstrated responsibility in billing, service encounters, claims auditing and coding.
Two (2) years' experience with Medicaid and Managed Care claims.
Two (2) years' experience working in electronic health care systems (EHRs). A strong comfort level with computers is required.
Must possess strong analytical, organizational, problem-solving and decision making skills.
Must be detail oriented and able to work on multiple assignments simultaneously in a fast-paced environment.
Must possess excellent customer service skills and the ability to work well with non-technical managers and end-users.
Ability to work well under pressure and deadlines, with minimal supervision, in a team environment and share tasks.
Proficient with Microsoft Office Suite products.
Must be able to pass and maintain a clear background record as required for healthcare organizations under state and federal contracts.
Must possess and maintain a valid Washington State Driver's License and auto insurance.
Bachelor's degree in finance, business, public administration, computer sciences or related social service (psychology, social work) is a plus.
Understanding of ICD10-CM, CPT, HCPCs or equivalency.
Understanding of behavioral health (mental health and substance abuse disorders) is a plus.
Experience working with Crystal Reports.
Knowledge of Behavioral Health Organizations (BHO), managed care organizations (MCOs) and State (DBHR/DOH) data requirements.
TYPICAL DUTIES & RESPONSIBILITIES:
Responsible for making sure all claims have the appropriate documentation and accurate data before submission.
Run claims scrubber reports to identify and correct claims errors.
Review claims to identify data entry errors, including patient demographic data, diagnosis, and procedure/service data including codes and modifiers. Examples of things to look for include an incorrect procedure code that is age specific, which would make the claim invalid. The scrubber flags those types of errors for correction prior to submission.
Identify and correct claims that are rejected after initial scrubber report for any missing information.
Ensure appropriate codes and modifiers are used.
Identify common claims errors and use as educational tool for clinicians. Assist in educating staff in requirements of documentation for proper reimbursement.
Assist in conducting internal audits of patient charges and corresponding documentation.
Research root cause reasons and propose solutions for issues leading to revenue loss and/or reduced reimbursement;
Demonstrate expert knowledge of the organization, regulatory agencies and current trends in ensuring compliance.
Work closely with software and application development teams to recommend changes to the organization's Electronic Health Record (Avatar).
Provide decision support to management and program development through the interpretation of data from a variety of internal and external sources.
Other duties as assigned.