Clinical Charge Audit Analyst

Core Responsibilities and Essential Functions

• Performs charge reconciliation functions daily to ensure appropriate billing of supplies and procedures.
• Resolve issues with supplies not crossing to charge capture. Works closely with Lawson and collaborates with the supply chain to ensure all new supplies are assigned proper SUP Codes and item numbers.
• Maintain a working knowledge of Logistics in the department.
• Maintains an extensive knowledge of cardiovascular anatomy and procedures in correlating supplies with procedures. Process Bill-Only requisitions for Pacemaker Devices and ICDs. Clears the high dollar / high quantity work queues daily to prevent billing errors and troubleshoot problems in a timely manner. Audit Implant record for devices and stents, add C Codes, troubleshooting the record for errors and resolving issues so that revenue can post.
• Works closely with the EPIC Cupid team to build new procedures and templates for staff to follow and update the supply preference list.
• Reviews and verifies all Diagnostic, Interventional, Surgical procedures performed in the Cardiac Cath Lab, Electrophysiology Lab, for accuracy of procedural coding and documentation to support coding compliance and coding regulatory standards. Use knowledge of coding and compliance guidelines to identify potential billing / reimbursement issues.
• Educate physicians and clinical staff on any and all coding changes quarterly to ensure complete and accurate documentation to support appropriate diagnostic and procedural ICD-10 and CPT-4 codes to the greatest specificity for the most accurate reimbursement for all Cardiovascular procedures performed in the Cath Lab, and EP Lab.
• Monitor and review Revenue Usage Reports daily to ensure revenue is posting.
• Participates in the AHQ Annual State Survey. Collects procedural data for Kennestone Cardiac Cath and EP Labs to be used for State regulatory and planning purposes.
• Works with Business Manager to reconcile EPIC data and correct query issues.
• Reviews procedural data and CPT codes for accuracy. Works closely with Decision Support and Clarity report writer to obtain accurate query of data.
• Assist in the Orientation and training of new staff to ensure correct and appropriate charging of procedures and supplies. Provide monthly in-service sessions to the Cath Lab and EP staff, addressing error trends and new modalities or procedures on the horizon.
• Research new technologies and new procedures for the Cath / EP Lab. Gather vital information on CPT and DRG reimbursement, estimation of cost of anticipated supplies required for procedures and available in-service opportunities for staff and physicians.
• Works with RMD to build charge codes for these new procedures and serves as Clinical and Coding Liaison. Provide training to staff for new procedure / coding and charging.
• Performs other duties as assigned
• Complies with all Wellstar Health System policies, standards of work, and code of conduct.