JOB OVERVIEW: Responsible for providing daily oversight of Revenue Integrity staff and functions including the timely, accurate and appropriate charging for all services at Valley Medical Center. Responsible for the maintenance and updating of the CDM in compliance with government/payor regulations and internal policies including price transparency and hospital pricing updates.
DEPARTMENT: Patient Financial Services
WORK HOURS: Monday - Friday, typically 7:30am - 4:00pm. Some flexibility may be required to meet department and organization needs.
REPORTS TO: Director, Revenue Integrity
PREREQUISITES:
- Bachelor's degree in healthcare, business or another related field required. An additional four years of relevant and applicable experience or a combination of education and experience may substitute degree requirement.
- Minimum five (5) years of experience in working with a medical office/hospital coding department or accounts receivable system, required.
- RHIT, RHIA, or CCS, CCS-P, COC, CPC with multi-specialty coding experience preferred.
- Minimum of two (2) years of supervisory or lead experience, preferred.
- Extensive knowledge of insurance payor reimbursement, and accounts receivable follow-up.
- Proficient in various computer applications, including Microsoft Office, Excel, Word, PowerPoint, Visio, and Outlook; Excel knowledge at an advanced level, preferred.
- Effective verbal and written communication skills.
QUALIFICATIONS:
- Ability to research authoritative citations related to coding, compliance, and additional reporting needs.
- Knowledge of Federal, State and contracted payers regarding current UB04-Rev codes, CPT4/HCPCS and ICD-9-CM, ICD-10-CM usage for billing and coding requirements for either facility or professional services.
- Experience with analyzing EOBs from various insurance payers, correctly interpreting contract terms for system configuration and problem solving with payers.
- Ability to gather, organize and present analytical reports reflecting the reimbursement impact of changes made to the charge master.
- Proven ability to interact with physicians and support staff.
- Attention to detail and excellent organizational skills are essential.
- Excellent customer service skills, including telephone interactions.
- Ability to prioritize and multi-task.
- Ability to work autonomously, with a minimum of direction, and take initiative in problem solving and exercise good judgment.
- Interact professionally and effectively with a wide audience, including operations staff, providers, the general public, and departments in VMC.
- Demonstrates knowledge of Medicare, Medicaid, and third-party coding requirements.
PERFORMANCE RESPONSIBILITIES:
- Responsible for the creation of new charges, and the modification of existing charges to reflect changes in CPT/HCPCS, revenue codes, or other industry reporting requirements, with a goal of ensuring compliance and reducing payer denials.
- Review and analyze coding, billing, and remittance advices/EOBs as it relates to how charges are set up in the charge master and charge entry.
- Participate on interdisciplinary work groups chartered with the implementation of new programs and services at Valley to ensure that charges for the new program are created prior to the start-up, and that all affected staff are aware of the charges for their area.
- Interact with Patient Registration, Health Information Management, Patient Financial Services (Billing and Follow Up), Accounting and Contract Management, to ensure that internal processes are coordinated for accurate and appropriate charging and billing.
- Maintain and update CDM pricing in alignment with organizational policies.
- Perform annual hospital pricing reviews and adjust facility and professional pricing with regards to contracted reimbursement, competitive environment, and organizational financial strategy as communicated by leadership.
- Act as the primary point of contact for adherence to CMS mandates and guidelines for Price Transparency.
- Assist with the monitoring or charge ticket creation processes and the electronic charge capture system to ensure accurate data collection.
- Ensure accuracy of Charge Description Master tables which enable appropriate billing and financial data.
- Responsible for working with the Director, Revenue Integrity and the VP, Revenue Cycle to develop, update policies and procedures for the Charge Master Management functions.
- Participate in task forces/committees/meetings to ensure data integrity, make recommendations for improved data collection and tracking mechanisms, and identify information needs and analysis.
- Responsible to review reporting designed to measure the impact of new charges or changes to charge master pricing.
- Communicate suggestions regarding charge processing and billing improvement opportunities to the CDM & Charge Capture Coordinator and department managers.
- Collaborate with outside professional contacts and payers on reimbursement issues and new developments.
- Attend educational seminars and professional meetings related to Charge Master Management and insurer regulations.
- Provide information/data/explanations to key customers including Physicians, Managers, and staff to assist the organization in assessing/improving the performance/reimbursement of health care delivery.
- Demonstrate awareness of the importance of cost containment for the department.
- Distributes and balances workload among available staff, assuring timely accomplishment of the work.
- Maintains confidentiality of all protected health information.
- Responsible for ensuring assigned work queues are monitored and worked daily.
- Monitors performance metrics to identify training needs, ensure staff are accountable to performance standards.
- Develops and trains best-practice workflows, and techniques. Provides applicable written instructions, reference materials, and tools for the job.
- Advises service line leaders and their staff on proper usage of charge codes, identifying opportunities for capturing additional revenue in accordance with payer guidelines, and develops specifications to modify existing charge capture applications to reduce charge-related claim edits/rejections.
- Weekly and monthly monitoring of revenue capture to ensure timely and accurate charge submissions.
- Leads and oversees a charge capture system to include regular and systematic reviews of all clinical areas to ensure accurate charge entry for all services provided.
- Keeps current on relevant areas of coding knowledge and acts as a resource to staff.
- Assists with the preparation and maintenance of department reports. Prepares scheduled reports for management as delegated by Manager.
- Attends UW and VMC audit meetings to ensure consistent understanding and communication between teams.
- Provides feedback and focused education on the results of auditing and monitoring activities to affected staff, providers and ancillary staff.
- Monitors various regulatory sources to provide education related to coding and keep management staff informed and trained on rules, regulations, and related issues.
- Works with Revenue Cycle management to identify denial trends; supports implementation of process improvements to reduce denials and or delays in billing relating to departmental areas.
- Participates in Epic upgrades and partners with IT as the subject matter expert for PB and HB charging.
- Utilizes tools established by management to ensure staff are performing at levels necessary to achieve organizational goals.
- Evaluates performance of assigned staff and provides regular reports to management on staff performance, issues and training needs.
- Provides on-the-job training to new employees.
- Assists with resolving employee complaints.
- Maintains employee records and reports as requested by management.
- Provides technical or clerical back-up to staff when indicated by departmental needs as time and priorities permit.
- Other duties as assigned.
Job Type: Full-time
Pay: $78,425.00 - $117,637.00 per year
Benefits:
- 401(k)
- 401(k) matching
- Dental insurance
- Employee discount
- Flexible schedule
- Health insurance
- Paid time off
- Vision insurance
Schedule:
- Day shift
- Monday to Friday
Work setting:
Education:
Experience:
- hospital coding or accounts receivable: 5 years (Required)
- supervisory or lead: 2 years (Required)
License/Certification:
- RHIT, RHIA, or CCS, CCS-P, COC, or CPC (Required)
Location:
Ability to Commute:
Work Location: Remote