Center City, Philadelphia, PA
The Charge Holder Coordinator/Charge Entry Sr. will be responsible for the daily comprehensive review of all Epic and outside charges and for the transplant services departments (Heart/VAD, liver, kidney, and pancreas). Assists Billing Manager in reviewing and updating all charges for transplant on a daily basis. Maintains the Charge Master for Transplant Services in collaboration with financial department. Reviews all charges, commerical, Medicare, hospital-based, provider-based inpatient and outpatient for “flagged” transplant accounts. Directs appropriate pre-transplant evaluation charges to the Medicare cost report client account, reviews pre-transplant charges for all other payors and ensures that they are appropriately logged/reported for purposes of Cost Report preparation. Ensures that charges are entered correctly for transplant episodes, paying particular attention to the organ acquisition charge. Ensure commerical insurances are billed properly, not held up by workqueue, and that accounts are tracked in a separate report for monthly review. Reviews the Medicare cost report client account monthly under the supervision of the Transplant Billing Manager. Reviews all post transplant charges to ensure appropriate flagging as transplant related for purposes of program financial reporting. Works closely with Jefferson’s financial, revenue cycle, PB, HB, and contracting team to reconcile incorrect billing, missed claims, and denials.
The position includes, but is not limited to the following essential functions
- Reviews all charges flagged as pre-transplant/evaluation charges for potential recipients and/or waitlisted patients. Verifies that the patient is in the pre-transplant/evaluation phase of transplant. Verifies that charges are appropriate and in line with evaluation protocols. Verifies any questionable charges with the clinical staff and manager. Directs charges appropriately to either the client account or to be billed to the patient’s insurer. Assures that those billed to the insurer are logged in such a way as to be reported for Cost Report preparation purposes.
- Reviews all charges flagged as related to living donors in any phase of donation. Verifies that the patient is a potential or actual living donor. Verifies that charges are appropriate to the phases of care for the donor. Directs charges appropriately to the client account, the recipient’s insurer, or and ensures live donors do not receive bills. Assures that those related to living donor evaluation which are billed to the recipient’s insurer and/or transplant office are logged in such a way as to be reported for Cost Report preparation purposes.
- Collaborates with financial coordinators and contracting team to ensure proper billing of accounts under global contracts/Center of Excellence agreements.
- Resolves claim inquiries from providers including, but not limited to submitting payment research requests to accounts payable, reviewing remittance advices, and reviewing the pt.’s chart and bundled episodes to validate claims.
- Initiates outbound phone calls to providers to obtain billing documents such as claim forms, W9s, etc.
- Invoice preparation for KPD billing to recipient centers.
- Manually prepares/processes claims utilizing the Medicare Fee Schedule and by means of the Request for Payment procedure.
- Reviews charges for all patients flagged as transplant to ensure that they are appropriately “transplant related”, removes flagging for those not transplant related.
- Completes research of claims and follow up with outside facilities and patients.
- Assists Billing Manager with various billing tasks as well as proving back up support in Billing Manager’s absence.
- Serves as point of contact for Transplant staff’s questions in reference to Transplant related charges and billing and work queues.
- Interacts with co-workers, visitors, and other staff consistent with the core values of the Hospital.
High School Diploma Required
Associate’s Degree Preferred
- Required: Minimum of two years healthcare experience in insurance, billing, coding, reimbursement, or other related area.
- Required: Working knowledge of Medicare, Medicaid and commercial insurance policies related to billing.
- Required: Excellent computer skills including at minimum Word, Excel, PowerPoint and Outlook.
- Recommended: Strong knowledge of EPIC and clinical terminology with the ability to navigate EPIC to abstract clinical documentation for billing analysis.
- Strong interpersonal skills.
- Ability to maintain strict confidentiality with regard to protected and sensitive information.
- Must be able to use critical thinking skills to solve problems independently by applying analytical and logical thinking.
- Ability to use standard office equipment and software proficiently.
- Demonstrate flexible and proficient time management techniques.
- Prioritize workload so as to meet productivity standards and applicable deadlines.
- Ability to communicate fluidly with Billing Manager on a continual basis about assignment status and issues.
- Establish and maintain positive interpersonal relations with internal and external customers.
- Ability to arrive to work on time and prepared to perform duties of position.
- Ability to work autonomously and communicate barriers and/or process improvement strategies to Billing Manager.
- Able to read and interpret reports, general business directives, and policy and procedure statements.
- Able to write routine business reports and correspondence.
- Able to respond to common inquiries and complaints from internal and external customers.
- Able to professionally communicate with internal and external end-users and coworkers. Able to organize and present basic reports and information to applicable internal parties.
Jefferson Health delivers state of the art healthcare services to patients throughout the Delaware Valley and southern New Jersey. Jefferson (Philadelphia University + Thomas Jefferson University) provides more than 8,400 students from nearly 40 states and 40 countries with 21st century professional education. Combined, we have over 30,000 employees.
Jefferson Health, with 14 hospitals (seven are Magnet designated by the ANCC for nursing excellence) and 40+ outpatient and urgent care locations, offers a broad range of primary and complex, highly specialized care that touches the lives of more than four million patients annually. U.S. News & World Report has ranked Thomas Jefferson University Hospital among the nation’s best in eight specialties. Jefferson Health also includes the NCI designated Sidney Kimmel Cancer Center; it is one of only 70 such centers in the nation.
Thomas Jefferson University has ten colleges and three schools that offer more than 160 undergraduate and graduate programs. Our University is dedicated to inter-professional and transdisciplinary approaches to learning that offer a vibrant and expandable platform for professional education. Through this unique model, we are preparing our students for current and yet to be imagined careers.
As an employer, Jefferson maintains a commitment to provide equal access to employment. Jefferson values diversity and encourages applications from women, members of minority groups, LGBTQ individuals, disabled individuals, and veterans.
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