Revenue Integrity Coordinator in Pinehurst, North Carolina at FirstHealth of the Carolinas

Position Specific Competencies:

1. Uses an appropriate problem-solving approach to plan services.

a. Responsible for aspects of Candidate for Billing (CFB) workflow including but not limited to pre-bill buckets, created buckets greater than 7 days, DNBS and STOP BILLS and claim edits.

b. Reviews CMS, FI and Carrier websites for Bulletin, Transmittals, Program Memorandums, Local

Medical Review Policies and other information impacting billing and reimbursement.

d. Educates and distributes relevant information to the appropriate staff.

2. Provides services with consideration of the recipient's needs.

a. Works with the RCM managers to improve flow of operations.

b. Works with management in solving problems, working out ways to improve productivity, and in handling special situations that may arise impacting RCM operations.

c. Serves as a resource for reporting CDM problems and assists in researching coding issues.

d. Assists other departments with problems concerning billing.

e. Assists with providing in-service training and continuing education for employees.

3. Uses equipment/supplies correctly.

a. Demonstrates proper use of computer systems, printers, copiers, and telephones.

4. Uses appropriate safety and infection control measures.

a. Complies with departmental and/or organizational safety and infection control measures.

5. Teaches/directs/advises/informs others in an appropriate manner.

a. Serves as a liaison between departments on billing and charging issues. Assists with identifying

sources of problems and works with the CDM Coordinator, RCM Analysts, and RCM leadership to implement corrective actions to ensure the chargemaster is updated and/or charge capture processes are reviewed to prevent future rejections/denials.

6. Reports/records information correctly.

a. Prepares routine and special reports and keeps RCM Analysts and leadership informed of trends which can impact cash flow.

b. Keeps billing policies and procedures updated.

c. Monitors the assigned WQs and works efficiently with departments to resolve issues. Provides analysis of any trends and fiscal impact to the organization.

d. Able to communicate with personnel in all areas of the Revenue Cycle and to provide recommendations to improve processes.

7. Ensures appropriate and timely verbal and written communication to administration,

departmental staff, and peers to facilitate flow and decision making.

a. Keeps administration informed of activities and concerns.

Qualifications: The following or equivalents are the minimum requirements necessary to perform the essential functions of the position.

Education/formal training/licensure/certifications/ experience:

High School graduate plus two years additional education in healthcare billing, accounting or business administration, or equivalent work experience may be considered in lieu of post-secondary education. Minimum three years of relevant experience in healthcare is preferred. CPC certification is preferred.

Additional Skills:

Strong interpersonal and verbal communication skills. Ability to manage multiple tasks in an organized manner. Excellent analytical and critical thinking skills. Computer literate. Knowledge of CPT-4, HCPCs, UB and ICD-10 Coding. Knowledge of CMS guidelines and requirements. Ability to work independently, exercising sound judgment, discretion, and initiative.

Physical Requirements:

Speaking and hearing are essential to effective communication. Mobility or working with hand and arm dexterity required.