About us

Somnia Anesthesia is a national anesthesia management company.
www.somniainc.com

Medical Billing Specialist Job Overview:

Somnia is actively seeking an experienced Billing Specialist to work onsite at Methodist Le Bonheur Hospital University Medical Center. The Billing Specialist will partner with the Regional VP of Ops and their colleagues, as well as Somnia corporate office staff. Strong interpersonal, organizational and time management skills are a must.

Somnia uses an external billing company (Coronis) and it is important for the specialist to understand and distinguish their duties from that of Coronis. That is, work they are expected to do, versus the work of others they are expected to oversee/audit. Moreover, although most cases involve electronic records, there are some that are generated on paper. This is complicated by the system’s transition from Cerner to Epic.

As an overview, the Billing Specialist needs to ensure that every clinical encounter resulting in a billed CPT code, from all facilities and anesthetizing areas, is completely and appropriately documented and leads to a properly paid claim, including but not limited to CPT codes for anesthesia, invasive lines, post-op pain rounds and blocks, inpatient and outpatient visits, and TEEs.

Medical Billing Specialist Duties:

1. Operations

a. Capture. Develop, implement, and manage a process permitting the timely captureof clinical activities occurring in each facility (Methodist University, North, South and Germantown); and at these facilities; all anesthetizing areas (e.g.; Operating Rooms, Labor and Delivery, Endoscopy, Structural Heart, Interventional Radiology, Interventional Neurosurgery suites; etc.) and all types of clinical activities (anesthesia, interventions, evaluation and management, etc.).

b. Reconcile all captured charges to those received by Coronis and also to the various schedules maintained by each area, as well as resolve all discrepancies.

c. Data remediation. Remedy any missing, incorrect, or outdated information. For example, transmit payor edit reports to Coronis.

i. Ensure that demographic edit reports are run every day and systems are updated to reflect changes (e.g.; insurance changes, name changes, etc.)

d. Transmission.

i. Electronic. Ensure that all data streams are complete, accurate and contain the required clinical and demographic information to prepare and process claims.

ii. Paper. Ensure that all clinical and demographic information is scanned and uploaded to server and that Coronis is accessing said information.

2. Information and Technology

a. Electronic Data Interchange [“EDI”]. Monitoring the development, implementation, testing and maintenance of an EDI between MLBH System EHR & EMR systems and Coronis by their respective IT Departments so that necessary, sufficient, and accurate datasets (clinical anesthesia records, surgeon op notes, consents, demographic and insurance info, etc.) required for claims processing is securely transmitted to billing vendor.

i. Scrub all data to ensure missing or incorrect information is resolved

ii. To the extent that Specialist becomes aware that an EDI is broken or not functioning properly: i) alert the respective IT departments; ii) ensure hand-off of the issue to IT Departments; iii) monitor remediation activities; and iv) notify VP of Operations and keep abreast of resolution.

b. Request for Information [“RFI”]. Continually monitor RFIs and promptly resolve.

3. Audit

a. Conduct audits of each billing provider of no less than 10 claims/year on areas that are relevant to risk management (e.g.; start/end times, supervision/direction, etc.) and, to the extent that imperfections are detected, re-train and re-educate the department or specific individuals.

4. Terminal Adjudication

a. Become fluent on hospital and Somnia self-pay policies and ensure adherence to them

b. Develop, implement, and maintain a process for the collection of all self-pay receivables, or support a Coronis process.

5. Education and training

a. Train Practice Administrators to thoroughly scrub paper or electronic records for all the pertinent information[1] as well as well as to otherwise support the RCM processes.

b. Prepare and deliver to the Anesthesia Department one (1) 15-minute lecture each quarter on a billing topic to the Anesthesia Department

6. Communication

a. Interact with hospital clinical and administrative staff as necessary to obtain additional information and to foster positive communication to enhance the access to timely, high quality, and accurate information on information pertinent to billing;

b. Interact Department Clinicians regularly and often, especially when needing their help on matters relevant to billing (e.g.; open charts, information validation, etc.)

c. Participate as a subject matter expert on information gleaned from role.

d. Participate in Dept Meetings as per 5.a.

7. Billing Company Liaison and Reporting, have the billing company…

a. generate a modifier AD report monthly identifying all cases billed with modifier AD

b. generate monthly report of claims paid at less than contractual allowables and the appeal status

c. provide a list of all network contracts which do not list allowables for non-ASA codes like lines, blocks, E/M

d. provide monthly report of average days to bill claims from receipt of clean claim

e. provide a list of payers who pay CRNAs less than anesthesiologists

f. provide a monthly list of patient balances recommended to be written off

g. provide their monetary threshold for appealing denied or underpaid claims

h. provide the monetary threshold at which patients are sent to collections

i. to provide monthly list of credit balances to government payers

j. to provide a list of the name of each post-op pain block billed with 64999, and showing which payers are paying 64999, and the average amount, and which payers are not paying 64999 and the unpaid billed amounts.

k. provide a list of how each payer pays OB CLE claims, i.e., flat fee, face time, monitoring time, monitoring time subject to a cap

We offer competitive compensation packages, including benefits such as health insurance, retirement plans, and paid time off. Join our team of dedicated professionals in providing quality healthcare services to our community.

Job Types: Full-time, Internship

Pay: $35,000.00 - $50,000.00 per year

Benefits:

• 401(k) matching
• Dental insurance
• Flexible spending account
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• Day shift
• Evening shift
• Monday to Friday
• Night shift
• Overnight shift
• Weekends as needed

Work setting:

• Hospital
• Medical office
• Office
• Private practice
• Teaching hospital

People with a criminal record are encouraged to apply

Application Question(s):

• Do you have experience in billing for anesthesiology services?
• How many years of experience do you have performing billing services for anesthesiology services?
• Please describe what parts of the revenue cycle management cycle you have experience in, by way of example:

i) preauthorization and verification,
ii) chart and document collection and reconciliation to schedule
iii) chart scrubbing
iv) submission to payor or billing company
v) working soft denials
vii) working hard denials
viii) addressing requests for more information
ix) talking with patients to secure balances due (e.g.; copays, deductibles, etc.)
x) liaison with billing company
xii) ensuring electronic data streams are intact and verifying transmission
xiii) creating process-related reports (e.g.; denial reports)
xiv) creating outcome-related reports (e.g.; NCR, GCR, variance from contract)

PLEASE DO NOT COPY AND PASTE THIS LIST AS A RESPONSE but briefly discuss and describe your experience and expertise!

Ability to Relocate:

• Memphis, TN: Relocate before starting work (Required)

Work Location: In person