Biller / Clinical Documentation Analyst

Employer
City of Hope
Location
Irvine, California
Salary
Competitive
Closing date
May 28, 2022

View more

Discipline
Life Sciences
Position Type
Full Time
Organization Type
Healthcare/Hospital

Job Details

About City of Hope

City of Hope is an independent biomedical research and treatment organization for cancer, diabetes and other life-threatening diseases.

Founded in 1913, City of Hope is a leader in bone marrow transplantation and immunotherapy such as CAR T cell therapy. City of Hope's translational research and personalized treatment protocols advance care throughout the world. Human synthetic insulin, monoclonal antibodies and numerous breakthrough cancer drugs are based on technology developed at the institution. AccessHope™, a subsidiary launched in 2019 serves employers and their health care partners by providing access to City of Hope's specialized cancer expertise.

A National Cancer Institute-designated comprehensive cancer center and a founding member of the National Comprehensive Cancer Network, City of Hope is ranked among the nation's "Best Hospitals" in cancer by U.S. News & World Report and received Magnet Recognition from the American Nurses Credentialing Center. Its main campus is located near Los Angeles, with additional locations throughout Southern California and in Arizona.

City of Hope's commitment to Diversity, Equity and Inclusion

We believe diversity, equity and inclusion is key in serving our mission to provide compassionate patient care, drive innovative discovery, and advance vital education focused on eliminating cancer and diabetes in all of our communities. Our commitment to Diversity, Equity and Inclusion ensures we bring the full range of skills, perspectives, cultural backgrounds and experiences to our work -- and that our teams align with the people we serve in order to build trust and understanding. We are dedicated to fostering a community that embraces diversity - in ideas, backgrounds and perspectives; this is reflected in our work and represented in our people.

Position Summary

Clinical Documentation Analyst is a certified professional who possesses clinical knowledge and professional/technical skills and is responsible for the audit functions of the City of Hope Medical Center charging system, Research Billing charge correction functions or review and processing of all City of Hope National Medical Center Radiation Oncology charges, including maintaining functional knowledge of ARIA radiation oncology management system. The Clinical Documentation Analyst utilizes clinical knowledge to properly identify documentation that reflects and supports the transactions of services rendered to the patients.

A key objective of the Clinical Documentation Analyst is to gather, review and provide clinical documentation to third party payers in support of the services provided to City of Hope patients. In addition, the Clinical Documentation Analyst analyzes charge transactions along with documentation to properly bill for related services provided to the patient. The Clinical Documentation Analyst also serves as a patient advocate and promotes customer satisfaction by appropriately explaining and resolving charge discrepancies. The Analyst participates in departmental and organizational performance improvement activities and appropriately communicates audit findings.

Key Responsibilities include:

Audit/Review documentation and charge capturing workflows to ensure efficiency and effectiveness. This includes:
  • Verifies medical procedure documentation and completeness of the Medical Record. Requests documentation as needed to support charges.
  • Coordinates/conducts entrance and exit audit interviews with third party payers in relation to patient bills. Recommends to management the appropriate actions and strategies to be taken.
  • Reviews medical records for appropriate documentation to appeal proposed clinical and technical denials
  • Conducts special patient charge studies. Develops data and provides interpretation of intangible or unusual factors and summarizes findings appropriately.
  • Interprets and explains to patients or family members the details of medical services provided, if requested.
  • Conducts department in-service training on an as needed basis.
  • Reviews and analyzes data required for internal and external audits as directed
  • Improvement of department processes and procedures to assure timely and accurate capture of all chargeable activities;
  • Development of action plan with responsible parties and due dates of issues identified;
  • Development of policies and procedures for timely and accurate charge capture mechanisms; Prepares report of findings for management
  • Development and maintenance of collaborative working relationship with Revenue Cycle departments and clinical personnel on issues related to the charge master and charge capture related processes
  • Analyzes charge transactions along with documentation to properly bill for related services provided to the patient; Assist with review and perform manual charge entry/correction as needed
  • Requests documentation as needed from clinicians/providers to support charges.
  • Maintains a record of audit/reconciliation account activity and takes appropriate follow-up actions
  • Maintains a record of audit/reconciliation account activity and takes appropriate follow-up actions
  • Participates collaboratively with Revenue Cycle team and hospital staff on issues related to the charge master and charge capture related processes
  • Any other audit/miscellaneous charge capture duties assigned

Additional Responsibilities:
  • Interprets and explains to patients or family members the details of medical services provided, if requested.
  • Conducts department in-service training on an as needed basis.
  • Performs other related duties as assigned or requested.


Basic education, experience and skills required for consideration:
  • Associate's degree or equivalent experience accepted
  • Five (5) years current related experience in an acute care facility or four (4) years of experience in Radiation Oncology
  • Work effectively with third party payers.
  • In-depth knowledge of medical record documentation. Working knowledge of hospital patient billing and managed care systems.
  • Foster and promote a positive image and professional appearance
  • Statistical analysis
  • Broad clinical knowledge
  • Compose letters/memorandums
  • Coordinate meetings
  • Research clinical and financial information
  • Use computerized spreadsheets to conduct analyses
  • Use computer packages to prepare graphics
  • Excellent oral/written communication skills

Required Courses/Training:
  • RN, coder or equivalent clinical documentation background.

Required Certification/Licensure:
  • RN or Certified Coding (CCS, CPC)

Preferred education, experience and skills:
  • Bachelor's degree, related field of business or healthcare

Preferred Courses/Training:
  • Insurance/contract billing and collections. Epic

Additional Information:
  • Full-time, day shift
  • Monday - Friday, 8:00am to 5:00pm
  • Exempt
  • As a condition of employment, City of Hope requires staff to comply with all state and federal vaccination mandates.

City of Hope is committed to creating a diverse environment and is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sex, sexual orientation, gender identity, age, status as a protected veteran, or status as a qualified individual with disability.

Company

City of Hope, an innovative biomedical research, treatment and educational institution with over 5,000 employees, is dedicated to the prevention and cure of cancer and other life-threatening diseases and guided by a compassionate, patient-centered philosophy.

Founded in 1913 and headquartered in Duarte, California, City of Hope is a remarkable non-profit institution, where compassion and advanced care go hand-in-hand with excellence in clinical and scientific research.  City of Hope is a National Cancer Institute designated Comprehensive Cancer Center and a founding member of the National Comprehensive Cancer Network, an alliance of the nation’s 20 leading cancer centers that develops and institutes standards of care for cancer treatment.

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