Scope of Position

The Failed Claims Specialist 2 functions in the revenue management unit supporting hospital claims processing and charge capture processes. Responsible for maintaining current knowledge of the various regulatory agency guidelines and assure requirements are met along with accurate, complete, and timely charge processes. The primary responsibility of staff within the Revenue Cycle division is to ensure the compliant collection of net revenue for services rendered.

Position Summary

The Failed Claims Specialist 2 reviews hospital claims to compliantly apply and resolve claim edits specific to non-Medical Information Management CPT/HCPCS coded charges. Responsible for charge capture for various infusion and emergency departments. Performs charge audits and provides feedback on any opportunities for improvement with charge code selection. Familiarity with medical claims processing and pre-bill edit experience for hospital accounts services which includes: modifiers, CPT, ICD10 and HCPCS; LCDs/NCDs; rejected claims after claim submission, and resubmission of encounters that have failed claim edit logic. May serve as informal resource for less experienced colleagues.

MINIMUM REQUIRED QUALIFICATIONS
High School diploma or GED. Certification or vocational training may be preferred. 1 year of relevant experience required. 2-4 years of relevant experience preferred.