Job Description

Charge Solutions Analyst

Full Time, 80 Hours Per Pay Period, Day Shifts

Covenant Health Overview:

Covenant Health is the region’s top-performing healthcare network with 10 hospitals, outpatient and specialty services, and Covenant Medical Group, our area’s fastest-growing physician practice division. Headquartered in Knoxville, Covenant Health is a community-owned integrated healthcare delivery system and the area’s largest employer. Our more than 11,000 employees, volunteers, and 1,500 affiliated physicians are dedicated to improving the quality of life for the more than two million patients and families we serve every year. Covenant Health is the only healthcare system in East Tennessee to be named a Forbes “Best Employer” seven times.

Responsible for analyzing, determining corrections, investigating cause, and leading actions to resolve claim processing issues. Uses CMS resources and source documentation as a compliance guide. Possesses and maintains a broad-based understanding of the clinical and business operations across a diverse group of hospitals and clinical departments. Works independently under limited supervision with significant latitude for initiative and independent judgement. Maintains all organizational and professional ethical standards. Performs additional tasks necessary to assist in team's overall success.

Responsibilities

• Responsible for analyzing claim conflicts, weighing options for presenting issue, independently determining the correct course of action, and responding appropriately to ensure compliance; meet regulatory guidelines for coding, charging, and billing; and with discernment for payment inducing decisions.
• Leads discussions and efforts to resolve complex claim issues with the business office and/or health information management related to charging, modifier assignment, and billing edits.
• Maintains knowledge and understanding of CMS NCCI Policies, Claims Processing Manual, CPT coding, and modifiers to ensure compliance with Medicare, Medicaid, and other State and Federal governmental agency’s procedural and regulatory guidelines.
• Independently resolves suspended, failed, and erroneous charges from the use of incorrect clinical documentation workflow.
• Responsible for investigation, cause analysis, and account corrections when charges are erroneously posted (i.e., Duplicated, Net Negative). Follows appropriate process for identifying related accounts from reports, delayed claims, and/or project assignments.
• Reviews and reconciles charge activity initiated by the Charge Solutions team for accuracy. Performs this daily with precision and addresses any discrepancies in a timely manner to allow correction prior to claim processing.
• Performs departmental monitoring to ensure compliance. Accepts feedback and education from monitoring results and Revenue Integrity audits as a learning opportunity. Takes appropriate action to follow through with corrections to the account.
• Effectively manages tasks and project assignments using prioritization and time management skills. Communicates to Sr. Charge Solutions Analyst concerns or when assistance with prioritization and timelines are needed.
• Effectively uses and monitors the compliance of electronic tools used to determine the appropriate charges.
• Recognizes situations, which necessitate supervision and guidance, seeking and obtaining appropriate resources.
• Participates in professional growth and development through continuing education, seminars, and applicable professional affiliations to keep informed in industry trends. Attends department meetings regularly.
• Displays willingness to generate a positive and harmonious relationship with all co-workers. Promotes good public relations and has a positive impact to the culture of the department and Finance Division.
• Assists with special projects/tasks.
• Follows policies, procedures, and safety standards. Completes required education assignments annually. Works toward achieving goals and objectives, and participates in quality improvement initiatives as requested.
• Performs other duties as assigned.

Qualifications

Minimum Education:

Associate’s degree preferred or equivalent experience sufficient to demonstrate possession of the knowledge, skill, and ability needed to perform the essential tasks of the job.

Minimum Experience:

One (1) to three (3) years of experience in charging, coding, or billing required. General understanding of healthcare, documentation, compliant charging practices, rules, regulations, and guidelines. Experience in problem solving and analytical reviews; must be knowledgeable in use of PCs, Windows, Excel, and Word Processing; must have good public relations skills.

Licensure Requirement:

None