Referral/Billing/Reimbursement Coordinator - Oncology Details

Referral/Billing/Reimbursement Coordinator - Oncology

UVA Medical Center - Charlottesville, VA

Employment Type : Full-Time

Provide billing and compliance support within the Division of Radiation Oncology to include; compliance and charge capture, referral/medical necessity, denial management/data collection and follow up, and project management. This position provides business support to clinic and administrative personnel within the Division of Radiation Oncology.

• Assures that all referrals are managed effectively and efficiently for Radiation Therapy Services. Provides high-level customer service to both referring physicians as well as referred patients. Verifies medical necessity for all radiation treatments based on patient’s diagnosis and medical insurance. This job requires the application and interpretation of policies and procedures and the use of independent judgment in a medical setting. The individual must possess the ability to maintain a working knowledge of carrier contracts/changes and departmental policies and procedures.
• Complete referral forms appropriately
• Enter necessary referral information into Epic
• Notify appropriate team members of pending referrals
• Inform patients of referral responsibilities
• Coordinate with financial coordinators regarding assistance
• Review insurance guidelines to determine if criteria is present for proceeding with planned treatment
• Consult with physician if addition information is necessary for medical necessity determination
• Coordinate peer to peer dialogue when required
• Maintain thorough knowledge of insurance company criteria and radiation specific billing codes
• Communicate with physicians, department billing team, and preauthorization team to ensure accurate pre-certification/authorization information is aligned with accurate billing of services
• Advocates for patients by helping them navigate through the system.
• Directs and assists patients, families, and staff in accessing appropriate resources.
• Develops tools to assess patient referral processes with respect to efficiency and customer service.
• Performs all other related tasks which would facilitate the flow of patients through the process, or which would enhance the quality of service to patients.
• Practice/procedure changes are implemented in a timely and correct manner.
• Review patient documentation to abstract clinical data information and assess appropriate level and assign the appropriate codes for radiation treatment and procedures prior to exporting to claim. Evaluation and Management – Consults.
• Check for signatures on the note
• Check dos/billing area/dr/dx covering physician/and check dx to see what anatomical site they are treating
• Check for any CCI Edits
• Check diagnosis code
• Check physician’s name
• Review Unexported charges for documentation
• Review Unexported charge list for sending second email reminders to Physicians
• Perform compliance QA on radiation oncology billing to ensure accurate coding (i.e., physician coverage, correct diagnosis, modifier and patient status, department)
• Ensure all technical and professional charges are appropriately captured and modifiers appropriately appended. (76, 58, 59, 25, 27, 1A, Q0, Q1, GC) This list is not complete
• Run Unexported Review
• Check (your charge capture system) and then EMR for the same DOS
• Check if 90 global periods are applicable
• Check if pt seen for xrt before within 3 years
• Check for a referring physician
• Apply appropriate compliance rules
• If consult note has not been dictated email attending and resident to place note and drop charge in epic.
• Resident/Fellow- The Physician may utilize the Residents note, by using a Teaching Physician Addendum. Ensure appropriate statements included in the documentation such as:
• He or she personally saw the patient.
• He or she personally participated in the management of the patient.
• He or she reviewed the Resident/Fellow note and discussed the case with the resident/fellow.
• New Patient Visit codes range from 99205-99201
• Inpatients Consult codes range from 99255-99251 – Codes phased out for Medicare
• Outpatient Consult codes range from 99245-99241 – Codes phased out for Medicare
• Outpatient follow up codes range from 99211-99215
• Additional CPT Codes and Documentation Requiring Review:
• Clinical Physician Treatment Plan (77261, 77262 77263)
• Data Acquisition Initial CT (77014 or 77011)
• Simulation (77280, 77285, 77290)
• Check Field Note in Simulation/Diagnosis and Intervention for custom immobilization devices used.
• Check Quality Check list Items for custom immobilization devices and Physician presence.
• Planning Clinic (99xxx or 31575)
• Weekly Management (77435, 77432, 77431, 77427)
• Check Nursing Assessments
• Resolve Radiation Course of Therapy
• Image Guided Radiation Therapy (Daily – 77421 or 77014)
• Special Treatment Procedures (77470)
• Special Physics Consultation (77370)
• Special Dosimetry (77331)
• PTC Apertures/Compensators (77334)
• Ensure all technical and professional charges are appropriately captured and modifiers appropriately appended. (76, 58, 59, 25, 27, 1A, Q0, Q1, GC) This list is not complete
• Review documentation for Radiation Plans
• Intensity Modulated Radiation Therapy Dose Distribution Plans
• Three Dimensional Reconstruction of tumor Volume dose distribution plans
• Isodose Plans
• Special Teleport Plans
• Dosimetry Calculations
• Treatment devices
• Physician Prescription for Radiation Therapy
• Review plan under Diagnosis and Intervention to review fields
• Review Treatment chart to confirm dates treatment devices of the fields will be used
• Check for different types of treatment modality (i.e. step n shoot, field in field, proton )
• Review Gantry Angles, Monitor Units, Control Points, Images.
• Review signatures
• Review dates
• Review documentation
• When discrepancy is found, communicate effectively with dosimetry and physics staff via email, phone, or face to face.
• Be actively involved in the development, implementation and management of an XRT-specific compliance program Brachytherapy and other Procedures and possess a strong clinical and technical understanding of Radiation Oncology.
• High Dose Rate
• Pulse Dose Rate
• Low Dose Rate
• Interstitial Seed Implant
• Pubic Arch Volume Studies
• Stereotactic Radiosurgery (SRS)
• Stereotactic Radiotherapy (Fractionated-SRT)
• Gamma Knife
• Eye Plaque
• Glia Site
• Endobronch
• Total Body Irradiation
• Total Skins
• Stereotactic Body Radiotherapy (Fractionated SBRT); Lung, Liver, Spine
• Export all Radiation Oncology charges
• Perform compliance QA on all Radiation Dosimetry Plan charges to ensure accurate billing.
• Intensity Modulated Radiation Therapy Plans
• QA Patient Schedule on IMRT plans to ensure correct treatment delivery
• Three Dimensional Reconstruction of tumor volume plans
• Isodose Plans
• Special Teleport Plans
• Dosimetry Calculations (correct #)
• Treatment devices (correct # per gantry angle)
• Verify Physician Prescription for Radiation Therapy matches dictation
• Email Billing Specialists at all sites for any discrepancies found for corrections.
• Perform QA on Physician Coverage for Main Campus,
• Perform QA on Physician Coverage Calendar for Outreach Facilities
• Complete schedules
• Communicate effectively
• Verify all charges went across accordingly by verifying on HUB report
• In addition to the above job responsibilities, other duties may be assigned.

MINIMUM REQUIREMENTS

Education: High School Diploma
Experience: 2 years relevant experience
Licensure: Relevant coding certification, such as Radiation Oncology Certified Coder (ROCC), from an accredited organization .

PHYSICAL DEMANDS

This is primarily a sedentary job involving extensive use of desktop computers. The job does occasionally require traveling some distance to attend meetings, and programs.

The University of Virginia, i ncluding the UVA Health System which represents the UVA Medical Center, Schools of Medicine and Nursing, UVA Physician’s Group and the Claude Moore Health Sciences Library, are fundamentally committed to the diversity of our faculty and staff. We believe diversity is excellence expressing itself through every person's perspectives and lived experiences. We are equal opportunity and affirmative action employers. All qualified applicants will receive consideration for employment without regard to age, color, disability, gender identity or expression, marital status, national or ethnic origin, political affiliation, race, religion, sex (including pregnancy), sexual orientation, veteran status, and family medical or genetic information.