Req Number 001RV4
Job Category Finance
Performs management reporting and financial analysis for physician practices. Provides analytical and operational support to CPP operations. Assists CPP management in planning and implementing policies and procedures resulting from changes in physician reimbursement.
Prepares financial and clinical reports using data extracted from the IDX system and other financial databases.
Demonstrates proficiency in using Microsoft Excel and Word to prepare reports and analyze data.
Creates and updates profiles for fees, procedures and clinical information.
Analyzes and uses Medicare, Blue Shield Validation Reports and Insurance Carrier Edit Lists.
Analyzes practice patterns as they affect revenue.
Collaborates with physicians, support staff and CPP staff to gather data for analysis.
Audits physician charge documents, i.e., superbills, billing cards and medical records, as needed to ensure physician compliance with regulatory agencies.
Maintains efficient communication with secretaries and billers.
Assists coordinators in directing support staff on proper CPP policies and procedures.
Identifies and proposes solutions to common work problems affecting secretaries and billers.
Reports these problems on a timely basis to CPP coordinator or CPP management personnel.
Maintains and updates CPP Procedure Manual.
Maintains and updates CPP Managed Care Quick Reference Guide.
Maintains and updates physician fee profiles.
Prepares analysis of impact on revenue from charges in third party fee schedules.
Maintains proficiency in third party reimbursement charges, CPT and ICD-9 Coding and RBRVS.
Tracks insurance payment and trends.
Contacts insurance carriers to appeal claims and obtain fee schedules.
Researches and contacts third party representatives to obtain information and clarify policy and procedures, as needed.
Follows-up on outstanding patient accounts as needed and documents results.
Provides guidance and training to support staff on carrier benefits and policies.
Demonstrates expertise in the use of DBMS to obtain information from the IDX system to prepare reports for analysis and presentations.
Performs queries in a timely fashion.
Updates IDX dictionaries.
Updates pricing module and enters updates to physician fee schedules.
Demonstrates expertise in IDX Bar application for assisting support staff and CPP representatives with routine problems.
Responds to requests for information and reports on a timely basis.
Works as a team with CPP staff, physician practices and other administrative personnel.
*ADA Essential Functions
EXPERIENCE AND QUALIFICATIONS
Bachelor’s Degree, required.
Minimum of three (3) years experience in physician billing with emphasis on practice management.
Extensive knowledge of CPT and ICD-9 Coding. Knowledge of federal, state, and third party rules and regulations.
Strong knowledge of IDX computer system. Expertise in spreadsheets and associated software programs. Strong oral, written, analytical and problem solving skills.