Billing Specialist Radiation Oncology

The mission of The University of Texas M. D. Anderson Cancer Center is to eliminate cancer in Texas, the nation, and the world through outstanding programs that integrate patient care, research and prevention, and through education for undergraduate and graduate students, trainees, professionals, employees and the public.

Function: Provide billing and compliance support within the Division of Radiation Oncology.  This position provides business support to clinical and administrative personnel within the Division of Radiation Oncology.  The incumbent’s time will generally be distributed as follows: 

ESSENTIAL FUNCTIONS

1.                  Compliance and Charge Capture

Review patient documentation to abstract clinical data information and address appropriate codes for Radiation Oncology Multi-Specialty procedures within the entire Division.

Review documentation for Radiation Therapy Treatment Dose Distribution Plans and Procedures.

·          Intensity Modulated Radiation Therapy Plans

·          Three-Dimensional Reconstruction of tumor plans

·          Isodose and Special Teleport plans

·          Brachytherapy plans

·          Dosimetry Calculations and Treatment devices

·          Simulation Procedures and Immobilization devices

·          Treatment delivery for External Beam, Stereotactic and Proton Therapy

·          Special Procedures; Gamma Knife, Brachy-Gyn, GU, Head Neck, Intraoperative Radiation Therapy

Reviews all Patient encounters to ensure both technical and professional competent charges are appropriately captured.

Performs compliance QA on radiation oncology billing to ensure accurate coding.  (i.e., physician coverage, DOS, diagnosis, and patient status) and charge reconciliation.

Complete final chart closeout to ensure accuracy of entire course of Radiation Therapy Treatment

• Review signatures
• Review dates
• Review documentation
• Verify all technical and professional charges captured per patient prescription and patient treatment plan.

2.                  Billing and Coding

Analyzes Medical documentation to abstract and assign appropriate ICD-10 diagnosis and Current Procedural Terminology -CPT, Healthcare Common procedure Coding System (HCPCS) codes in accordance to coding guidelines.  Applies guidelines as indicated through the Local Coverage Determination (LCD), National Coverage Determination (NCD), as well as the National Correct Coding Initiative (CCI). Ensures accurate code assignment (s) of all relevant diagnosis, procedures, and/or modifiers.

Maintain coding knowledge and skill through attending continuing education activities and reviewing pertinent literature, attending institutional coding meetings, seminars, and other coding educational forums. Be actively involved in the development, implementation and management of Radiation Oncology specific documentation requirements and billing processes.

Communicate effectively with physicians and other staff to provide continuing education and feedback on documentation issues and/or lacking sufficient information for coding purposes. 

Communicate effectively with Manager to note any patterns or continue education efforts and/or discrepancies in documentation.

Must meet and maintain production and quality standards.

3.                  Data Collection and Follow Up

Review and Follow-up on missing physician documentation, maintain assigned physician Brocade worklist to ensure accuracy of bi-weekly auto physician email reminders.

Upon the physician receiving at least three reminder emails, the specialist will perform the final follow-up and capture the charges if there is completed documentation. Abstract and enter appropriate missed opportunity codes in Radiation Oncology MosaiQ system for proper monthly reporting.

4.            Epic WQs

Review Radiation Oncology Epic charge review WQ’s for HB and PB Review charges to resolve charge edits and resubmit charges, (i.e., modifier, diagnosis review, multiple procedure check, CCI, MUE, etc.) to properly process claims.

Review Radiation Oncology claim edit WQ’s for HB and PB; Resolves claim and billing edits by performing second review making appropriate code modifications and re-submit clean claims.

Review Epic denial follow up WQ’s for PB and PTC analyze denial and provide resolution for appeal; process charge corrections if applicable, prepare for appeal of third-party payor denials or provide documentation for PBS team to resubmit claim, (i.e., bundling, experimental/investigational, level of service not supported, etc.).

5.            Project Management

Initiate and complete special projects and studies within designated timelines.

Demonstrate strong organizational skills as they relate to prioritizing tasks and presentation of key elements for each project.

Demonstrate and apply the ability to involve key personnel to meet project objectives.

Effectively and consistently communicates project status to all involved parties through project Completion.