JOB PURPOSE:
Manages the enhancement and overall effectiveness of patient net revenue realization and minimizes revenue leakage for the hospital revenue cycle. Directs and assists in the development and implementation of process enhancements for enterprise and departmental initiatives to improve charge capture accuracy and reimbursement. Provides education to clinical department leaders specific to charge capture and revenue monitoring responsibilities.
Manages and coordinates daily Revenue Integrity operations, to include timely and accurate edit resolution, audit, and education activities related to hospital charge capture.
Responsible for understanding departmental charging processes, including electronic health record charge capture interfaces, claims denial analysis and claims processing compliance to support revenue cycle goals while working with the Director in assessing, identifying, and resolving potential revenue cycle billing compliance risks.

KNOWLEDGE, SKILLS, ABILITIES

• Advanced knowledge of revenue code, CPT and HCPCS coding.
• 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.
• Effective oral and written skills, including formal presentation skills.
• Well-developed research skills.
• Ability to interpret and implement regulatory standards.
• Working knowledge of multiple healthcare applications, including but not limited to Epic, 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.
• Excellent organizational and project management skills.
• Ability to travel as needed

MINIMUM EDUCATION REQUIRED:
Bachelor's degree in Business Administration, Healthcare Administration, Health Information Management or a related field is required.
In lieu of degree, six (6) years of relevant work experience will be accepted in addition to the experience requirement.

MINIMUM EXPERIENCE REQUIRED:
Five (5) years of progressively responsible revenue cycle experience involving chargemaster, revenue integrity, quality assurance and/or auditing activities to include one (1) year involving leading people, projects, or programs.
(If no degree, a total of eleven (11) years of experience required.)

MINIMUM LICENSURE/CERTIFICATION REQUIRED BY LAW:
None.

ADDITIONAL QUALIFICATIONS:
AHIMA certification (e.g. RHIA, CCS, RHIT); AAPC certification (e.g. CPC, CPH, CA) or applicable clinical or professional certifications/licenses such as RN, RT, MT, RPH, ARRT required.
Master's degree preferred.
Superior written and verbal communication skills including the ability to present ideas in a clear and compelling manner to both executive and staff level audiences.
Experience working with EPIC.

KEY RESPONSIBILITIES:
1. Monitors productivity, quality, and performance of direct reports; conducts staff performance appraisals; provides leadership and direction by supporting and motivating staff; manages the development, coaching and mentoring of staff.
2. Manages the hiring and training of staff; ensures necessary follow up occurs; effectively assigns tasks to personnel with appropriate skill sets; develops, implements, and monitor adherence to departmental policies, procedures and budgets; prioritizes work projects to ensure all deadlines are satisfied.
3. Monitors Epic charge-related work queues and partners with individual department leaders as needed to provide timely resolution of charge capture issues.
4. Coordinates charge capture audits activities to include planned, ad-hoc, denial, and patient disputes; develops and maintains annual audit plan to proactively ensure accurate and optimal revenue capture in compliance with standard charging guidelines; ensures maintenance of audit database and standard reporting tool to track and report audit process; tracks any findings and facilitates charge capture education for applicable departments.
5. Identifies financial opportunities and threats proactively and communicates findings to senior leadership in a timely and effective manner; partners with leadership to develop solutions as necessary.
6. Works with department managers to develop and implement policies and procedures for purposes of reconciling posted charges with other measures and sources of information.
7. Reviews the charge structure of revenue generating departments to assure the charges accurately reflect services and supplies provided and are structured consistent with current industry standards and governmental regulations.
8. Maintains current with all regulatory issues that affect billing and compliance; educates directors and managers of revenue generating departments in the management of their respective service line; ensures coordination of coding between CDM and HIM.
9. Evaluates system edit logic and provides recommendation on enhancements to prevent revenue leakage and support billing compliance.
10. Other responsibilities as assigned.

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