Business Analyst, Charge Reconciliation Representative - Surgical Services

at  Ascension

DETAILS

• Department: Surgical Services
• Schedule: Part Time, 24 hrs. Days - 0700-1530, flex scheduling day shift.
• Hospital: Ascension Providence Rochester
• Location: Rochester, Michigan
• This position is onsite and not a remote position.

REQUIREMENTS

Education:

• High school graduate required.

Work Experience:

• Two (2) years college course work in business disciplines and/or medical related disciplines or two (2) years or more working experience in hospital surgical ordering, billing or charge capture activity within the last 3 years required.
• Knowledge of coding including CPT, ICD-9, and HCPCS codes plus the function each of these play on patient/insurance charges is required.
• Working understanding of the Revenue Cycle functions from service rendering to payment received is required.

The Perioperative Charge Reconciliation Representative is responsible for supporting the Mission and Vision of Ascension by, under the supervision of the Department Manager or designee, assisting in planning, organizing, implementing and evaluating revenue charge capture and unit of service activities. As the chosen care delivery model, Relationship Based Care (“RBC”) is the foundation of compassionate patient care at Ascension, supported by all team members.

The 6 elements of RBC:

• Element 1: Caring and Healing Practice Environment
• Element 2: Responsibility for Relationship and Decision Making
• Element 3: Work Allocation and Patient Assignments
• Element 4: Communication with the Health Care Team
• Element 5: Leadership/Management
• Element 6: Process Improvement – provides the building blocks for patient care and service delivery within the Ascension organization and the focus of the three primary relationships – self, colleague, and patient. Supports the caring practice and the commitment to co-workers.

Essential Functions

• Track and document the location of all manual charge sheets assigned for use in the Perioperative Services area.
• Read patient finalized OR chart segments, including preop, procedural and PACU documentation from nursing staff, to research all charge issues. Check for completeness according to specified guidelines and ensures inclusion of vital demographic data necessary for proper charging.
• Electronically process all daily Perioperative department charges multiple times per day utilizing the McKesson STAR and SurgiNet systems accounting for all Perioperative registrations.
• Completes patient EMR record review comparison with auto charged items to ensure proper billing and/or missing charge data.
• Log each incomplete chart, including deficiency, discovery date and assigned staff member to correct issues.
• Monitor for discrepancies in patient charging function of the Perioperative Services Department and communicates with involved departments when problems arise. Facilitate the complete resolution of charge outliers.
• Coordinate with vendors’ representatives to assist the Charge Description Master Coordinator, Nursing and Distribution in new item set up or item charge issues.
• Review charge stickers and pref card sheets to ensure items noted by RN as being used are properly charted and applied against a patient’s bill and resolve any items in dispute.
• Review and resolve any Cerner suspended charges including Free Text items noted during nursing documentation to ensure proper charges are applied.

Non-Essential Functions

• Verify Purchase Orders against the SurgiNet Discern Analytics Implant Log of cases, SurgiNet Charge Viewer to ensure items have been documented by the OR RNs and resolve issues working with the service line OR RN Manager and/or distribution.
• Assist the IS Business Manager or Nurse Manager to research charge capture audits in a timely manner according to established procedures.
• Maintain established record-keeping and filing systems, classifying, sorting and filing patient, department records and reports. Assists with determining department statistics, logs and charges for procedures performed.
• Participate in formulation or change of policies and procedures related to Charge Capture.
• Work with Registration when necessary to resolve McKesson account number discrepancies as needed. Coordinate communication between nurses and physicians.
• Maintain SurgiNet item location master file to reflect OR related item location changes and updates.
• Assist in maintaining all Joint Commission and other regulatory compliance standards.
• Maintain a working knowledge of applicable Federal, State, and Local laws and regulations as well as current knowledge related to practice excellence in specialty area.
• Assist in orientation of new staff to coordinator duties.
• Demonstrate the ability to multitask. Function in an organized and time conscious manner.
• Support and conduct one’s self in a manner consistent with service expectations.
• Attend educational programs and completes mandatory educational requirements in the time required.
• Promote a positive work environment as evidenced by quality service and positive staff attitudes.
• Demonstrate and actively promote an understanding and commitment to the mission of Ascension through performing behaviors consistent with the Ascension Standards of Performance and Code of Ethics.
• This position shall have access to and disclose personal health information only when reasonably necessary to perform the designated job related responsibilities. Disclosure and/or use of personal health information for any purpose other than as reasonably necessary for designated job responsibilities are prohibited.
• Perform other related duties as assigned or requested.
• This position requires the ability to identify age related differences within the persons served and the adjustment of treatment style and expectations as appropriate, including adjustments based on the person’s served cognitive function and learning ability. This will include taking into account their religious and cultural needs and preferences. ,