SUMMARY
The Clinical Billing Specialist (CBS) is responsible for ensuring accurate and timely charge capture, documentation, and reconciliation for complex oncology service lines for assigned oncology centers in accordance with institutional policies, and applicable regulatory standards and requirements. Attention to detail, good customer services skills and communication with clinical support teams and management is necessary in this position. Experience in infusion billing is a big plus as well as working knowledge of CPT and HCPCS codes. Experience using Epic billing system is a plus.
Clinical Billing Specialist opportunity in Ambulatory Charge Capture Services department. The ideal candidate will have an Associate's degree in Business Administration or related field and three years professional fee or technical billing experience in healthcare, insurance, or related field.
Prefer candidates with experience charging/coding in a professional practice or facility with experience in infusion charging/billing. Working knowledge and experience of CPT, HCPCS, state and local billing guidelines is a plus. Epic billing system experience is also a plus.
Charge Capture
· Performs daily charge capture review to verify clinical center(s) charges are captured in the billing system and are posted in an accurate and timely manner in accordance with institutional policy ADM0403 - Charge Submission and Reconciliation Policy.
· Charges are reviewed to ensure charges are posted to the correct cost center for revenue mapping using appropriate reports and/or work queues within the EHR and billing systems.
· Monitors all charge processes and entries for accuracy and timeliness, research compliance issues, coordinates compliance education and communicates routinely to management by providing recommendations to improve charge capture and reconciliation.
· Maintains ongoing education of coding and billing changes in accordance with industry standards as well as Institutional Billing Compliance for CPT-4 and HCPCS codes and local and federal guidelines.
· Knowledgeable review of documentation to support charges with a good understanding of anatomy and medical terminology according to coding/billing and documentation guidelines as applicable to state and federal regulations.
· Open Encounters - review daily for open encounters. Contact clinical support team members to resolve any charge or encounter issues.
· Initiates charge corrections as appropriate. Determine corrective action and make necessary updates to resolve errors for appropriate billing of claims.
· Communicate any inaccuracies or challenges identified immediately to management which exist in creating barriers to meet institutional policy and timely charge capture.
· Maintains standardized workflows and productivity as designated by department management and institutional policies.
Charge Reconciliation
· Reconcile charges daily to identify possible missing charges and ensure accurate and timely charge submission for services rendered in assigned center(s).
· Appropriate reconciliation tools will be used daily, including charge reconciliation report(s), other clinical documentation tools and designated work queues to ensure charges for services rendered are compliant and documentation is in the EMR to support compliant billing.
· Communicates effectively with nursing staff regarding missing or incomplete charges or documentation to ensure charges are compliant and submitted accurately and timely.
· Communicate inaccuracies for resolution and corrective action while working within and across multiple centers in collaboration with management for charges and revenue mapping.
· Maintains standardized workflows and productivity as designated by department management and institutional policies.
· Assists with training of clinical support teams and other billing specialists and will train and work across different areas as needed.
Project Management and Follow-Up
· Assists in monitoring billing compliance and may assist in conducting staff education sessions as appropriate.
· Assist with analysis of Charge Description Master and maintenance to identify new charge services and supplies and ensure accuracy of charge entry on an on-going basis.
· Assists with collecting and summarizing data related to special projects.
· Develops, implements, and monitors reconciliation and audit processes to ensure all inpatient and outpatient charges are appropriately captured and provides reports of activities as required.
· Identifies and communicates process improvement strategies, inaccuracies for resolution and corrective action to management in a timely and routine manner.
Other duties as assigned.
EDUCATION
Required: Associate's degree in Business Administration or related field.
Preferred: None
EXPERIENCE
Required: Three years professional fee or technical billing experience in healthcare, insurance or related field. May substitute required education degree with additional years of professional billing experience on a one to one basis.
Preferred: Experience in a professional practice or facility with experience in infusion charging/billing. Working knowledge and experience of CPT, HCPCS, state and local billing guidelines is a plus. Epic billing experience is also a plus.
LICENSURE/CERTIFICATION
Required: None
It is the policy of The University of Texas MD Anderson Cancer Center to provide equal employment opportunity without regard to race, color, religion, age, national origin, sex, gender, sexual orientation, gender identity/expression, disability, protected veteran status, genetic information, or any other basis protected by institutional policy or by federal, state or local laws unless such distinction is required by law. http://www.mdanderson.org/about-us/legal-and-policy/legal-statements/eeo-affirmative-action.htmlAdditional Information

• Requisition ID: 168374
• Employment Status: Full-Time
• Employee Status: Regular
• Work Week: Days
• Minimum Salary: US Dollar (USD) 51,000
• Midpoint Salary: US Dollar (USD) 64,000
• Maximum Salary : US Dollar (USD) 77,000
• FLSA: non-exempt and eligible for overtime pay
• Fund Type: Hard
• Work Location: Remote (within Texas only)
• Pivotal Position: No
• Referral Bonus Available?: No
• Relocation Assistance Available?: No
• Science Jobs: No

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