GENERAL SUMMARY:

Facilitates improvement in the overall quality, completeness and accuracy of the Revenue process. Works independently and is responsible for reviewing and analyzing information to identify trending and root-cause for billing and reporting issues. Develops and implements action plans for addressing and resolving all billing/charging issues. Provides support, education and guidance to Clinical and Administrative departments to maximize appropriate revenue for the Healthcare System.

PRINCIPAL JOB FUNCTIONS:

1. *Commits to the mission, vision, beliefs and consistently demonstrates our core values.

2. *Responsible for reporting in the Revenue Integrity area.

3. *Establishes and monitors revenue related Key Performance Indicators (KPI), metric goals, and reporting for the Revenue Integrity functions for the organization.

4. *Establishes and maintains department level revenue reconciliation reports and tools.

5. *Monitors department owned charge review work queue volumes.

6. *Coordinates the Regional Medical Center Revenue Integrity Functions.

7. *Analyzes revenue impact associated with various projects to determine priority and value.

8. *Coordinates the activities of the Revenue Integrity team and ensures quality output on assignments.

9. *Provides regular status updates to Revenue Cycle leadership and communicates relevant concerns and issues to the department as a whole as needed.

10. *Coordinates Revenue Integrity resources and tracks department risks and mitigation progress.

11. Maintains up-to-date knowledge of regulatory changes impacting charging practices.

12. Acts as a resource to Revenue Integrity Associates for complex questions, complicated cases, and compliance information.

13. *Manages and ensures a compliant chargemaster.

14. Works with department directors on developing new charges and pricing.

15. Revises and updates the chargemaster when need arises.

16. *In conjunction with the Regional Director of the Revenue Cycle, coordinates the bi-monthly denials taskforce.

17. *Ensures the denials taskforce is working towards avoidance on all avoidable denials throughout the Regional Medical Centers.

18. *Coordinates the Denials team to ensure that denials inventory is worked, and write-offs comply with the current policy and procedure.

19. Maintains professional growth and development through seminars, workshops, and professional affiliations to keep abreast of latest trends in field of expertise.

20. Participates in meetings, committees and department projects as assigned.

21. Performs other related projects and duties as assigned.

(Essential Job functions are marked with an asterisk “*”. Refer to the Job Description Guide for the definition of essential and non-essential job functions.) Attach Addendum for positions with slightly different roles or work-specific differences as needed.

REQUIRED KNOWLEDGE, SKILLS AND ABILITIES:

1. Knowledge of HIPAA rules and regulations and experience related to privacy laws, access and release of information.

2. Knowledge of Inpatient Prospective Payment System (IPPS), Coding Regulations and documentation requirements.

3. Knowledge of charge master components (CPT codes, HCPCs, Revenue Codes, G/L and Cost centers).

4. Knowledge of inpatient, outpatient and clinical billing requirements.

5. Knowledge of coding guidelines and CMS reimbursement methodologies.

6. Knowledge of HIPAA rules and regulations and experience related to privacy laws, access and release of information.

7. Knowledge of Inpatient Prospective Payment System (IPPS), Coding Regulations and documentation requirements.

8. Knowledge of computer hardware equipment and software applications relevant to work functions.

9. Skill in Epic Resolute Hospital Billing.

10. Skill in excellent communication and interpersonal skills.

11. Skill in coaching and educating peers and department directors.

12. Ability to be highly organized with strong analytical skills.

13. Ability to establish and maintain effective working relationships with all levels of personnel, medical staff, ancillary departments and volunteers.

14. Ability to prioritize work demands and work with minimal supervision.

15. Ability to communicate effectively both verbally and in writing.

16. Ability to maintain confidentiality relevant to sensitive information and HIPPA guidelines.

17. Ability to meet high standards for work accuracy and productivity.

18. Ability to maintain flexibility and prioritizes daily responsibilities.

EDUCATION AND EXPERIENCE:

High school diploma or equivalency required. Associate’s degree in business or healthcare related field preferred. Minimum of five (5) years’ experience in the hospital setting, healthcare industry or coding with a focus in one or more of

the following areas: coding, charge, revenue integrity; charge reconciliation; charge compliance; charge auditing; CDM management required. EPIC experience preferred.