Pre-billing Specialist Position

Jennbrisbon

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Wondering if anyone has any input on this. My current position at a hospital is verification of benefits and authorizations for outpatient procedures. I recently obtained my CPC (yay!!) and was looking to apply for a coding position in our billing department.

Upon talking to my current manager about leaving my current department she stated that they really wanted to create a position for a CPC in pre-arrival. Basically they want someone on the front end that reviews orders and codes applied for medical necessity prior to completion of tests and possible denials. We are currently testing this out for our cardiovascular tests and it has worked really well in making sure that the correct documentation from the chart and ICD-10 codes are applied prior to the patient even coming in for testing.

They would like to expand this position to include some of our more complicated outpatient procedures to review charts and communicate with the clinical team to ensure that the medical necessity and all authorization requirements have already been met prior to receiving denials and potential write-offs occurring.

I was wondering if anyone on this forum has performed a job similar to this or is familiar with what the job description and salary for a position like this would look like? Any help and insight would be greatly appreciated as my manager has asked for my help in helping to create this position for submission to HR.
 
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I perform these duties at our local hospital. I review all scheduled outpatient procedures including advanced imaging, dietary, radiology, cath lab, GI procedures, sleep studies and surgeries. I provide our case management department a list of the scheduled surgeries and note which surgeries are considered "Inpatient Only" and provide them with the number of days that have been authorized. I also review all medicare chemotherapy orders to be given in our outpatient infusion department to insure that medical necessity has been met according to our local LCD's. This is an area where we have a large margin for error when it comes to certain meds including immunoglobulins, aranesp, and iron infusions. Also infusions for Reclast, etc. for osteoporosis. We find that we may have the correct procedure authorized but the place of service is wrong or the date is wrong. I prepare the ABN's and notify patients if their testing is not covered and have the ABNs available in the registration area for them to sign upon admission. I also review our medical necessity pre-bill edits for any missing diagnoses. I report directly to the Director of Patient Access. I am a registered nurse and also a CPC. My salary is commensurate with nursing wages at our facility. I work in Florida so we have a high volume of Medicare patients and managed medicaid which requires an authorization for most procedures. This process has decreased our denials. We now find that most of our denials are for medical necessity for Inpatient admissions vs Observation.

Kaye Dafoe RN CPC
 
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