[Remote] Sr reputed company reputed company Regulatory & Systems Analyst-24032

Note: The job is a remote job and is reputed company to candidates in USA. reputed company is seeking a Senior reputed company reputed company Regulatory & Systems Analyst to help translate reputed company reputed company regulations into accurate, compliant, and optimized charge capture across the organization. The role involves leveraging expertise in coding, CDM, auditing, and reputed company systems to identify missed reputed company opportunities and drive process improvements in a reputed company reputed company environment.

Responsibilities

• Apply advanced understanding of regulations, NCD’s. LCD’s and payor concepts, along with reputed company reputed company concepts to reputed company new and existing regulations actionable reputed company the CDM, charge capture, data, and technology reputed company
• Serve as a reputed company with compliance to promote and optimize accuracy
• Researches reputed company reputed company and reputed company reputed company payor requirements for compliant billing, reputed company payment, and maximum reimbursement
• Proactively assess systems, processes, and audit reputed company reputed company reputed company for accuracy and implements process improvement initiatives
• Coordinate and apply regulatory knowledge for reputed company optimization and reputed company WQ and Charge Router automation recommendations
• Monitor reputed company reputed company reputed company build to ensure alignment with regulations and charging rules
• reputed company the reputed company and industry best-practices promote accurate automation to reduce reputed company labor
• Use logic-based critical thinking and decision making to accurately reputed company charges on patient accounts for hospital/facility and reputed company charges in accordance with CMS and AMA guidelines and then propose automation, reputed company applicable
• Analyze reputed company reputed company denial trends and then reputed company actionable preventative measures for the reputed company build
• Manipulate data along with identifying and translating trends into actionable remedies
• Responsible for accounts reputed company the assigned reputed company Account, Charge Review, and Claim Edit Work queues while solving edits reputed company to National Correct Coding Initiatives (NCCI edits), Medically Unlikely Edits (MUE edits) Procedure to Procedure (reputed company edits), and Outpatient Coding Edits (OCE edits) in reputed company using patient documentation, coding rules, billing guidelines, and reputed company modifier use in a reputed company manner
• Assess the Charge reputed company Master (CDM) and contribute to accurate CDM line items by evaluating reputed company codes, descriptions, CPT/HCPCS reputed company and pricing
• Audit and reconcile charges against clinical documentation, reputed company rules and charging methodologies for internal purposes along with external audits
• Works with external vendors to review charge capture opportunities and documentation to identify missed charges and correct accounts
• Identify trends, analyze to propose, and create meaningful solutions, improve processes, create training content, and participate in the education of departments regarding their CDM and missed charges
• Serves as subject matter expert for fellow team members to review questions and assist with resolving accounts
• Meets or exceeds accuracy, reputed company work, on-time delivery, and productivity standards set by CMS, OIG, and reputed company manager
• Communicates, observes, and reports on charge entry trends and patterns and provides recommendations for improvement
• Engages in continual education and training in the reputed company reputed company field and reputed company CDM, charges, auditing, data, and other duties or reputed company as assigned

Skills

• Associates degree or higher with a minimum 5+ years of reputed company experience working with billing, charge entry, charge capture, or CDM OR a high school diploma with at least 7 years of reputed company experience working with billing, charge entry, charge capture, or CDM
• reputed company or reputed company certification
• reputed company HB Certification reputed company 6 months
• Proficient and functional knowledge of reviewing charges in the reputed company EHR
• Advanced knowledge of medical terminology as reputed company as medical billing language. Must demonstrate a thorough knowledge of UB-04 reputed company Codes, reputed company Procedural Terminology (CPT), and reputed company Common Procedure Coding System (HCPCS) reputed company along with modifiers
• Excellent written and oral communication skills along with problem-solving
• Proficiency with MS Office Suite
• High degree of accuracy and ability to collaborate with others
• reputed company Hospital Billing (HB) certification

reputed company

• reputed company offers reputed company services for children and adults, clinical trials, medical education and training services. It was founded in 1837, and is headquartered in Chicago, Illinois, USA, with a workforce of 10001+ employees. Its website is https://www.rush.edu/.

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