[Remote] Billing Reviewer I CTSI

Note: The job is a remote job and is open to candidates in USA. Advocate Aurora Health is a leading nonprofit integrated health system in the United States, seeking a Billing Reviewer I to join their team. This entry-level position involves performing charge capture and claim resolution for clinical research studies, ensuring accuracy in billing processes within the EPIC system.

Responsibilities

• Performs review of all technical and professional charges generated from EPIC and any ancillary subsystems for allocation 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 outlined in the protocol Billing Grid
• Performs remediation of charge errors discovered during EPIC review
• Identifies appropriate use of billing modifiers and other CMS requirements for billing research-related charges to federal and non-federal payors
• Verifies and resolves discrepancies by utilizing the tools and resources available, e.g., EPIC billing system, OnCore (clinical trial management system), medical record documentation, Charge Master data, Patient Accounting/VMG Business Offices and/or contacting study personnel in 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 and study coordinators in the development and implementation of educational activities related to charge capture improvement projects
• Supply all missing information and correct inaccurate data as needed
• Processes charge related corrections/additions/removals in EPIC for both the hospital and physician billing to ensure organizational compliance with all state and federal regulations
• Calculates and facilitates the refunding of inappropriate reimbursement in collaboration with WFBMC Financial Services. Responsible for the movement of funds and correction of fees in EPIC
• Follows established hospital and physician departmental guidelines and state and federal regulations to assure the most productive and compliant outcome when processing charge related corrections
• Perform specialized duties involved in the preparation and processing of particularly complex charge issues
• Audit and review accounts to ensure accuracy; investigate and correct errors, follow-up on missing account information, and resolve past due accounts
• Identify insurance issues that need to be forwarded and addressed by the appropriate insurance teams. Report issues to the appropriate supervisor as needed
• Prioritizes job tasks; demonstrates willingness to assist Manager/Director in the completion of special projects and daily task to support the Department's productivity and efficiency
• Demonstrates responsibility for personal development by participating in continuing education offerings
• Performs other related duties, as assigned

Skills

• High School Diploma or GED required
• Medical terminology, knowledge of accounts payable and receivable processes preferred
• Minimum of 1-year business office experience in a healthcare environment or Research Office experience preferred
• Excellent oral and written communication skills
• Excellent phone etiquette and internal/external customer service skills, required
• Strong interpersonal skills and attention to detail
• Experience with computerized databases (e.g., Microsoft Excel), word processing (e.g., Microsoft Word), and presentation software (e.g., Microsoft PowerPoint)
• Demonstrates ability to work independently
• Associates Degree preferred
• Minimum of 1-year related coding/reimbursement experience preferred
• CPC or RHIT certification preferred

Benefits

• Benefits Eligible: Yes
• Remote Work
• Base compensation listed within the listed pay range based on factors such as qualifications, skills, relevant experience, and/or training
• Premium pay such as shift, on call, and more based on a teammate's job
• Incentive pay for select positions
• Opportunity for annual increases based on performance
• Paid Time Off programs
• Health and welfare benefits such as medical, dental, vision, life, and