Scope/General Purpose of Job:Under minimal supervision, the Client Resource Manager will train business office staff to ensure comprehensive knowledge of Radiation & Medical Oncology Coding and Billing policies to include all locations and payers. Reviews payer appeal packets from the AR Department prior to submission and serves as a coding liaison for clients and staff and conforms to applicable RC Billing guidelines and regulations.
Essential Duties & Responsibilities:- Research & obtain Coding Guidelines applicable to each client (State) i.e., Medicare, Medicaid
- Research & obtain Coding Guidelines for commercial payors, i.e., Aetna, BCBS, etc.
- Disseminate Coding Guidelines to RC Billing staff
- Provide Coding training specific to Radiation to RC Billing staff monthly via Go To Meeting utilizing actual accounts to review
- Provide RC Billing staff training applicable to payer Coding Guidelines as needed (published revisions)
- Updates reimbursement knowledge by participating in educational opportunities. (Rad Onc & Med Onc Coding)
- Reviews and approves payer appeal packets prepared by AR staff prior to submission to the payer to ensure medical record documentation is accurate, complete and applicable to the claim(s) being appealed
- Strong knowledge of healthcare reimbursement, coding, and billing procedures.
- Must possess excellent time management skills to ensure time lines are obtained
- Ability to read, analyze, and interpret technical procedures and/or government regulations.
- Ability to write reports, business correspondence, and assist with RC Billing procedure manuals.
- Prepares letter of medical necessity for payer appeals when applicable
- Performs all reimbursement functions in strict accordance to CMS regulations and all local, state, and federal laws.
- Ability to respond to common inquiries or issues from payers
- Ensures strong communication with management and team members
- Ensures compliance with RC Billing's reimbursement policies and procedures to maximize efficiency
- Ensures compliance with appropriate industry regulations and state and federal regulations
- Maintains working knowledge of applicable laws and regulations as they relate to assigned responsibilities
- Maintains confidentially of all information related to patients, medical staff, finances and cost-effective health care delivery issues
- Strives to achieve goals and benchmarks set forth by RC Billing
- Demonstrates the ability to work well with peers while ensuring a strong cohesive team
- Maintains confidentiality of assigned logins and passwords to access hospital data sets
- Demonstrates the discipline to work in a remote setting
- Additional duties as assigned.
Education and/or Experience:- Bachelor's degree required
- Registered Radiation Therapist with a minimum of 5 years of clinical experience preferred
- Coding certification required as appropriate for the position
- Maintains licensure as a Radiation Therapist, Nurse, and/or Medical Dosimetrist, if appliable
- Previous management experience
- Must have payer relations experience in a healthcare environment
Qualifications:- Knowledge of organization policies and procedures.
- Microsoft Office experience is required
- Must be tech savvy to include Adobe and Outlook 365
- Intermediate user of Excel required
- Detail oriented and professional at all times
- Ability to communicate effectively and professionally.
- Ability to establish and maintain effective professional working relationships with all employees and clients.
- Knowledge of CPT-4 and ICD-10 coding.
- Knowledge of Allscripts, Misys/Tiger, Allscripts Pro PM and Practice EDI Insight preferred.
- Ability to communicate effectively orally and in writing.
- Must have a HIPAA compliant workspace and reliable internet with a secure connection.