Clerical Specialist Position Available In Muscogee, Georgia

Clerical Specialist
Columbus, Georgia
Facility St. Francis-Emory Healthcare
Req

ID 541620

Post Date 05/01/2025 Category Administrative
Description
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 Revenue Cycle 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 Revenue Cycle 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
Qualifications
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