SCL Health is a faith-based, nonprofit health care organization headquartered in Broomfield with facilities located in Colorado, Kansas and Montana. SCL Health operates:
Our ministry is dedicated to improving the health of the communities and individuals we serve, especially those who are poor and vulnerable.
Works designated accounts to resolve claim edits prior to billing, valuates and provides guidance related to billing or clearinghouse system edits, and provides guidance and education to care site departments related to charging, coding, modifiers, value codes, and required medical record documentation to support accurate billing.
Â· Analyzes and resolves specific billing edits delaying claims from processing within Epic and/or clearinghouse systems which require clinical knowledge and/or coding expertise, including verification and/or correction of billing data for accuracy and completeness following regulatory requirements, care site protocols, SCL Health standard, and supported by medical record documentation. Resolutions may include charge correction or the application of modifiers, value codes and condition codes, as appropriate.
Â· Provides analysis and guidance for system changes that are not aligned properly between the organizations operating systems and the billing software utilized by SCL Health.
Â· Evaluates system edit logic and provides guidance on enhancements to either begin holding claims for compliance review or remove logic so claims are released without holding.
Â· Identifies charging, coding, or clinical documentation issues and works with appropriate leadership, ancillary departments, Revenue Service Center, care sites, Charge Master and/or system services to resolve.
Â· Performs compliance charge audits by verifying billing data as compared to documentation and making corrections within Epic as needed. Recommends process improvements to care site ancillary department directors in order to improve documentation, charging flow, and accuracy.
Â· Evaluates and enhances workflows that reside in charge capture, billing, reporting and documentation for hospital based services to maintain a level of compliant billing practices.