Professional Charge Entry Analyst

Job Profile Summary

This role focuses on activities related to revenue cycle operations such as billing, collections, and payment processing. In addition, this role focuses on performing the following Operational Strategy & Optimization duties: Ensures departmental technical and operational optimization, develops strategies for technology/applications used within the department, provides the reporting/analytics necessary to inform strategic operational decisions, identifies and proposes operational-optimization opportunities, and identifies and facilitates the delivery of, departmental training/continued education needs. An organizational related support or service (administrative or clerical) role or a role that focuses on support of daily business activities (e.g., technical, clinical, non-clinical) operating in a "hands on" environment. The majority of time is spent in the delivery of support services or activities, typically under supervision. An experienced level role that requires basic knowledge of job procedures and tools obtained through work experience and may require vocational or technical education. Works under moderate supervision, problems are typically of a routine nature, but may at times require interpretation or deviation from standard procedures, and communicates information that requires some explanation or interpretation.

Job Overview

The position reviews all ambulatory professional and technical charges prior to bill approval to ensure all data is accurate, all services are reported with a focus on accuracy of POS, bill area, department, DOS, compliant reporting of service and billing provider, and all charges on the technical side are appropriately applied.

Job Description

Minimum Qualifications:

1. High school diploma or equivalent

2. Three (3) years of experience in a physician billing/administrative setting.

3. A valid driver's license is required for local travel to remote hospital sites

Preferred Qualifications:

1. Bachelor's Degree

Duties and Responsibilities: The duties and responsibilities listed below are intended to describe the general nature of work and are not intended to be an all-inclusive list. Other duties and responsibilities may be assigned.

1. Supports the physician practices with ambulatory professional and facility charges.

2. Ensures ambulatory professional charges are up-to-date, completed and approved timely.

3. Oversees the hospital-based clinic billing process and ensures all charges are submitted on the technical side.

4. Reconciles charges; regularly running reconciliation reports to ensure all charges are captured.

5. Reviews charges in the EMR; alerting providers of any issues with their charges and appending charges and modifiers when appropriate.

6. Ensures pricing is present, and diagnosis codes are linked appropriately. Queries the provider as necessary.

7. Works with coders to ensure all charges are accurate and correct as well as to develop plans to improve charge capture and billing/coding processes. Attends coding meetings to learn proper codes to support the procedures.

8. Works with practice managers to ensure all notes are complete and encounters signed. On a monthly basis, meets with the practice managers to report high denials and/or frequently observed errors.

9. Acts as a liaison between the ambulatory office and Finance/Coding.

10. Organizes meetings with clinical and administrative staff educating on billing issues.

11. Regularly works Coding Denial WQs to correct and resubmit claims on a timely basis.

12. Troubleshoots charges that reject. Flags and e-mails providers and staff on issues rejecting the charge. Works with the providers and staff to educate, correct and submit charge.

13. Follows policy and procedure on all billing and coding and stays current with CPT and ICD-10-CM coding guidelines and updates.

14. Reports any potential compliance issues to the director.

15.Complies with departmental and company-wide policies and procedures.

16.mMeets or exceeds required departmental deadlines and goals on a consistent basis.

17. Maintains strict confidentiality in accordance with HIPAA regulations and company policy.

Physical Requirements:

1. Frequent sitting, occasional standing & walking, and lifting of 5-10 lbs.

2. Mental requirements will be intense at times with involvement in many concurrent multi-faceted projects

3. Requires manual dexterity using fine hand manipulation to operate a computer keyboard or related equipment

4. Requires ability to see computer screen, monitoring equipment and reports

Skills & Abilities:

1. Ability to present a positive, professional appearance and conveys a professional demeanor in the performance of assigned duties.

2. Excellent computer skills

3. Ability to pay attention to detail

4. Familiarity with electronic medical record systems and billing and coding systems

5. Proficiency in Excel, Word, Power Point and databases such as Access.

6. Strong organization, communication, financial and data analysis and technical skills

7. Ability to multitask in a fast-paced environment

8. Ability to problem solve

9. Extensive knowledge of CPT, ICD, HCPCS codes and medical terminology

10. Ability to handle confidential information and abide by HIPAA laws

Tufts Medicine is a leading integrated health system bringing together the best of academic and community healthcare to deliver exceptional, connected and accessible care experiences to consumers across Massachusetts. Comprised of Tufts Medical Center, Lowell General Hospital, MelroseWakefield Hospital, Lawrence Memorial Hospital of Medford, Care at Home - an expansive home care network, and large integrated physician network. We are an equal opportunity employer and value diversity and inclusion at Tufts Medicine. Tufts Medicine does not discriminate on the basis of race, color, religion, sex, sexual orientation, age, disability, genetic information, veteran status, national origin, gender identity and/or expression, marital status or any other characteristic protected by federal, state or local law. We will ensure that individuals with disabilities are provided reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. Please contact us to request accommodation by emailing us at careers@tuftsmedicine.org.