Employee Type:

Regular

Work Shift:

Day - 8 hour shift (United States of America)

Join Team Tidelands and help people live better lives through better health!

Position Summary of Duties/Responsibilities :

1. Evaluates current charging and coding structures and processes in clinical departments to ensure appropriate capture and reporting of revenue and compliance with government and third party payor requirements.

2. Provides guidance, communication and education on correct charge capture, coding and billing processes to multiple clinical departments and practices.

3. Assist with developing departmental program planning, strategy and goals for increased revenue integrity.

4. Analyzes business processes, clinical processes, coding processes to identify possible inefficiencies and makes recommendations to improve procedures, prevent future losses and to optimize reimbursement based on compliance standards.

5. Acts as primary revenue cycle liaison for the most complex clinical departments.

6. Perform data collection, tracking and analytical duties to respond to key issues, increase revenue integrity and process efficiency in support of the strategic initiatives and goals.

7. Responsible for ongoing development and reporting of executive summaries and detailed key performance improvement indicators with the development of performance metrics as a part of the plan.

8. Work collaboratively with clinicians, auditors, revenue cycle teams to understand services provided to explore and capitalize on opportunities for enhanced revenue integrity (minimize charge leakage, maximize compliance reimbursement).

9. Prepare departmental summaries that pinpoint root causes of charging/billing errors and conceptualize process changes for service line leaders, uses hospital denial data to support findings.

10. Collaborate with revenue assurance leadership to develop education plans to assist clinical service line leaders in achieving optimal reimbursement.

11. Oversees and evaluates orientation and training of assigned associates. May provide input in the review and evaluation of staff performance.

12. Performs complete revenue cycle reviews, including Charge Description Master (CDM) and related audits with a focus on revenue cycle integrity.

13. Ability to reduce manual rework and denials by performing root-cause analysis and implementing best practices.

14. Provides expertise in the evaluation of new technology, services and programs.

15. Analyzes changes to coding and billing rules and regulations by utilizing appropriate reference materials, internet sources, seminars and publications.

16. Other duties as assigned - Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee partner for this job. Duties, responsibilities and activities may change at any time with or without notice .

QUALIFICATIONS

Education :

• Must meet one of the following:

o Associate Degree or In lieu of degree, six (6) years of relevant work experience will be accepted in addition to the experience required and one of the below certifications

o Preferred Bachelor’s degree from a recognized college or university and one of the below certifications

MINIMUM LICENSURE/CERTIFICATION PREFERRED:

AHIMA certification (e.g. RHIA, CCS, RHIT); AAPC certification (e.g. CPC, CPH, CA) or applicable clinical or professional certifications/licenses such as LPN, RN, RT, MT, RPH, ARRT, CHFP, CRCR, CSAF, CSBI, CSPR, CSPPM preferred.

Preferred Qualifications:

Hospital outpatient coding experience preferred.

Experience in hospital charging/billing or performance charge review preferred

Dual Hospital and Professional Coding Certification(s) preferred. (CPC, CPC-H, CCS, CCSP) is preferred. Expert knowledge of CPT/HCPCS coding rules, Charge Master build/maintenance, Clinical charging practices, and billing regulations and practices.

LPN, RN and/or clinical operations experience a plus.

Experience :

• At least six (6) year previous experience in a healthcare related setting with knowledge in insurance payer regulations of primary/secondary coverage, required.

• Understanding of Revenue Integrity procedures and policies, required.

• Must have advanced revenue code, CPT and HCPCS coding knowledge.

• Ability to review, analyze and interpret managed care contracts, billing guidelines, and state and federal regulations.

• Solid understanding of multiple reimbursement systems including IPPS, OPPS, and Fee Schedule.

• Excellent interpersonal and communication skills to positively interact with a variety of hospital personnel, including administrative and management staff.

• Highly skilled experience and knowledge of Windows-based software required, including but not limited to Microsoft Windows, Outlook, Excel and Access.

• Possess effective oral and written skills, including superb formal presentation skills.

• Working knowledge of multiple healthcare applications, including but not limited to EHR, Med Assets, 3M and CDM maintenance software.

• Advanced knowledge of accurate sources for updating all applicable code sets (CPT/HCPCS, ICD10, etc.) inclusive of associated edits such as NCCI.

• Well-developed research skills.

• Excellent organizational and project management skills.

Physical Requirements : Light Physical Agility Test (PAT) Rating

While performing the duties of this job, the employee is frequently (activity or condition exists from 1/3 to 2/3 of the time) required to stand, sit, and walk; frequently to use hands, fingers; and frequently to talk or hear. The employee must exert up to 15 pounds of force occasionally (activity or condition exists up to 1/3 of the time), and/or up to 5 pounds of force frequently, and/or a negligible amount of force constantly to move objects.

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.

Tidelands Health is an equal opportunity employer (EOE). Tidelands Health does not discriminate against employees or applicants for employment on the basis of race, color, creed, religion, age, national origin, disability, marital status, veteran status, gender, genetic information, familial status, or any other legally protected status.