Description & Requirements At St. Luke's, we pride ourselves on fostering a workplace culture that values diversity, promotes collaboration, and prioritizes employee well-being. Our commitment to excellence in patient care extends to creating an environment where our team can thrive both personally and professionally. With opportunities for growth, competitive benefits, and a supportive community of colleagues, St. Luke's is truly a great place to work.
What You Can Expect: - Reviews clinical documentation, coding and hospital or professional fee charge and claim information in accordance with clinical trial coverage analysis document to ensure accuracy and appropriateness
- Uses auditing and analysis techniques to determine if the items and services provided to patients enrolled in clinical trials are to be billed to Medicare, other third-party payers or internal Research accounts
- Responsible for working EPIC account work queues, charge review edits, claim edits, denials, etc. while ensuring the accuracy and completeness of all Research-related charges within EPIC for accurate and timely billing
- Identifies and applies appropriate use of billing modifiers and other Center for Medicare and Medicaid Services (CMS) requirements for billing Research-related charges
- Refers to clinical trial documents including the protocol, informed consent form, Clinical Trial Agreement (CTA) and budget to review Research patient accounts
- Ensures documentation supports the level and type of service billed in compliance with billing regulations, provider documentation, procedures and coding guidelines
- Maintains a thorough understanding of coding classification systems, anatomy and physiology, medical terminology, pharmacology, disease processes, and surgical techniques
- Addresses Research billing questions from Research clinical/operations staff
- Serves as the technical expert for complex Research billing workflows
- Collaborates with pre- and post-award Research Finance Analysts to ensure that the clinical trial budget, coverage analysis, and billing grid are all consistent and appropriate
- Reviews patient visit data in Clinical Trial Management System (CTMS) and audits consistency with electronic medical records
- Maintains current knowledge of applicable Research and coding rules and regulations to ensure ongoing compliance by the organization
- Able to read, identify, and extract pertinent information from complex clinical trial protocols
- Able to vary communication styles internally with clinical teams, non-Research Revenue Cycle Coders and Denial Specialists, Patient Financial Services and other members of the Research Finance team and externally with third-party payers
- Routinely handles confidential patient information and sensitive financial information
- Requires a highly detail-oriented and analytical individual who is able to simultaneously manage hundreds of clinical trials with very similar attributes
- Participates in the identification, development, implementation, and improvement of department policies and procedures
- Performs other duties and responsibilities as assigned.
Qualifications: - Education: High school diploma or equivalent
- Experience: 2-year relevant experience
- Licenses/Certifications: Must have at least one of the following credentials: AAPC-CIC (Certified Inpatient Coder), CCS (Certified Coding Specialist), COC (Certified Outpatient Coder), CPC (Certified Professional Coder), CPC-H, CRC (Certified Risk Adjustment Coder), RHIA (Registered Health Information Administrator), or RHIT (Registered Health Information Technician)
Preferred:
- Experience in Clinical Research Billing and/or Billing Compliance
- Knowledge of Medicare's regulations regarding clinical research coverage and other federal and state laws and regulations concerning clinical documentation, coding, and reimbursement for hospitals and/or physicians
- Experience with Epic (electronic health records system)
- Experience auditing the coding of others
- A demonstrated understanding of Research Billing Compliance including the CMS Clinical Trial Policy
- Experience with electronic Clinical Trial Management Systems
What's In It For You At St. Luke's, caring for people in the communities we serve is our mission - and this includes our own SLHS team. We offer a robust benefits package to support our teams both professionally and personally. In addition to a competitive salary and retirement plans, we ensure our team feels supported in their benefits beyond the typical medical, dental, and vision offerings. We care about you and have fantastic financial and physical wellness options, such as: on-site massages, on-site counseling via our Employee Assistance Program, access to the Personify Health Wellness tool, as well as other formal training and career development offerings to ensure you are meeting your career goals.
St. Luke's is an equal opportunity employer and does not discriminate against any person on the basis of race, religion, color, gender, gender identity, sexual orientation, age, national origin, disability, veteran status, or any other status or condition protected by law.
*Please note: this posting is not reflective of all job duties and responsibilities and is intended to provide an overview to job seekers.