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Job Type:

Regular

Scheduled Hours:

40

💙 Why You’ll Love Working with St. Elizabeth Healthcare

At St. Elizabeth Healthcare, every role supports our mission to provide comprehensive and compassionate care to the communities we serve. For more than 160 years, St. Elizabeth Healthcare has been a trusted provider of quality care across Kentucky, Indiana, and Ohio. We’re guided by our mission to improve the health of the communities we serve and by our values of excellence, integrity, compassion, and teamwork. Our associates are the heart of everything we do. 

 

🌟 Benefits That Support You

We invest in you — personally and professionally.

Enjoy:
- Competitive pay and comprehensive health coverage within the first 30 days.
- Generous paid time off and flexible work schedules
- Retirement savings with employer match
- Tuition reimbursement and professional development opportunities
- Wellness, mental health, and recognition programs
- Career advancement through mentorship and internal mobility

Job Summary:

This position performs review, correction, and feedback on Professional Services departmental charges. In concert with SEH Billing, HIM and Denials, works to assure the completeness, timeliness and accuracy of Professional Services’ claims. Performs prospective and retrospective audits. Utilizes available technology to detect coding and billing errors. Works with clinical managers to assure accurate and complete chargemasters via annual review.

Demonstrates respect, dignity, kindness and empathy in each encounter with all patients, families, visitors and other employees regardless of cultural background.

Job Description:

Mon-Fri 8am to 4:30pm

• Conducts reimbursement audits consistent with National Care Billing Audit Guidelines and St. Elizabeth’s Corporate Compliance Program to determine charge accuracy and deficiencies.  Identifies reimbursement gaps and updates charges to include appropriate billing/coding (modifiers) as related to defense audits, charge capture, ABNs, billing edits using manual resources and automated workqueues. 
• Identifies trends and areas of opportunity strategies to reduce charge edits, support appropriate charge capture, reduce third-party payer denials, and improve compliance. Provides Assists in developing comprehensive reporting and analysis.
• Understands Medicare, Medicaid and commercial/managed care contract payment guidelines (including carve-outs) to support and flag correct reimbursement. Assists in the reviews and follows-up on edits, denials, appeals, and lost claims.
• Effectively communicates edit/audit/denial findings to the various departments throughout the organization in order to prevent issues or missed opportunities. Provides training and education to staff regarding trends of CMS, NCCI, and AMA changes. Participates in policy/procedure/work plan designs as new audits/edits are uncovered.
• Adheres to the National Care Billing Audit Guidelines and St. Elizabeth’s Corporate Compliance Program while performing all duties detailed.
• Assists with new charge development and CDM support and maintenance.
• Performs other duties as assigned.

Education, Credentials, Licenses:

• Associate degree in a healthcare or similar field
• Certified coder required within 6 months of hire into role.

Specialized Knowledge: 

• Knowledge of the operational process of charge capture in clinical units
• EPIC, HIM/EHR software
• Excellent interpersonal skills for interfacing with department heads, third party auditors, hospital personnel and patients

Kind and Length of Experience: 

• 2 years of medical audit, coding, or healthcare related field experience

🌟 Benefits That Support You

We invest in you — personally and professionally.

Enjoy:
- Competitive pay and comprehensive health coverage within the first 30 days.
- Generous paid time off and flexible work schedules
- Retirement savings with employer match
- Tuition reimbursement and professional development opportunities
- Wellness, mental health, and recognition programs
- Career advancement through mentorship and internal mobility

FLSA Status:

Exempt

Right Career. Right Here. If you're looking for the right careers in healthcare, the right place to be is at St. Elizabeth. Join us, and you'll take pride in the level of care we offer our community.