Clinical Charge Audit Analyst

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Work Shift

Wellstar Paulding in Hiram, Georgia is seeking FT Clinical Charge Audit Analyst. The Clinical Charge Audit Analyst provides clinical documentation improvement, auditing, coding and charge entry for all diagnostic, interventional, structural heart and surgical cardiovascular procedures performed in the Cardiac Catheterization Labs and Electrophysiology Labs.

a. This includes chart and report review and supply / implant inventory utilized. Reviews clinical documentation in the procedural event log and provides coding and compliance training to physicians, clinical personnel, billing and/or hospital staff.
b. Conducts medical record reviews to ensure accurate and appropriate documentation, coding, charging and billing practices to ensure compliance and to meet coding regulatory standards.
c. Review's documentation to ensure that the appropriate diagnostic and procedural ICD-10, CPT-4 and HCPCS codes can be assigned to the greatest specificity for appropriate reimbursement.
d. Reviews and verifies that the coding, demographic, encounter and charge related information is entered correctly into the patient record.
e. Works in conjunction with Compliance, RMD, the CTO, and HIM departments for correct coding and billing of Clinical Trials and new procedures being evaluated and performed in the Cardiovascular department. Research new procedures gathering information on CPT and DRG reimbursement, the cost of supplies required for the procedure and in-service opportunities for staff and physicians.
f. Works with RMD to build charge codes for these new procedures and serves as Clinical and Coding Liaison.
g. Responsible for seamless image acquisition into the MERGE / PAC's system.
h. Works closely with Lawson and collaborates with supply chain to ensure all new supplies are assigned proper SUP codes and item numbers and troubleshoots issues that prevent charges from posting. Maintains clinical expertise and extensive knowledge of cardiac anatomy and cardiovascular procedures correlating to supplies. Process Bill-Only requisitions for Pacemakers and ICD's.
i. This position is responsible for working with the Epic team to provide the necessary procedure information that is integral in data development for the AHQ Annual State Survey. Responsibilities include collection of procedural data for Kennestone Cath & EP labs to be used for state regulatory and planning purposes reported annually.
j. Also serves as back-up coding support for the Vascular Institute when VI Coder is out.

Core Responsibilities and Essential Functions:
a. Performs charge reconciliation functions daily to ensure appropriate billing of supplies and procedures.
b. 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.

c. Maintain a working knowledge of Logistics in the department.

d. 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.
e. Works closely with the EPIC Cupid team to build new procedures and templates for staff to follow and update the supply preference list.
f. 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.
g. 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.

h. Monitor and review Revenue Usage Reports daily to ensure revenue is posting.
i. 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.

j. Works with Business Manager to reconcile EPIC data and correct query issues.

k. Reviews procedural data and CPT codes for accuracy. Works closely with Decision Support and Clarity report writer to obtain accurate query of data.
l. 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.
m. 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.

n. 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.
o. Performs other duties as assigned
p. Complies with all Wellstar Health System policies, standards of work, and code of conduct.

Required Minimum Education:

High School Diploma / GED General

Required Minimum License(s) and Certification(s):
All certifications are required upon hire unless otherwise stated.

Additional License(s) and Certification(s):

Required Minimum Experience:
Minimum 3 years of acute care coding or billing or charge capture experience. Required and
Minimum 5 years Clinical Interventional Cardiovascular/EP, IR and/or Surgical experience Required and Computer/data entry experience. Required

Required Minimum Skills:

Ability to communicate with various members of the healthcare team.
Ability to use EXCEL, Word and have basic computer operational knowledge.

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