Job Description
The candidate is responsible for overseeing and maintaining specifically assigned system Charge controls, developing enhanced charge reconciliation functions at the department level, CDM maintenance, and governmental updates related to Revenue Integrity and Compliance. Provide all levels of support to Luminis Health facilities to ensure revenue recognition, including issue resolution for assigned areas of responsibility. Responsibilities are to resolve issues and assist others with resolving problems related to Revenue Integrity. Position communicates to internal and external users all corrections, changes and provides education to the facilities and internal customers. Reviews system charge reports and identifies trends, educational needs, workflow problems, and potential system issues. Generates monthly reconciliation reports and facilitates daily/weekly calls to review the data with the department's heads, hospital administrators, and CBOs. Ensures that any reconciliation issues are resolved promptly. The position will require reviewing specific account details to support other employees, CBO staff, or Administration when there are questions regarding the charge reconciliation process. They will analyze revenue cycle systems, including reporting data to maintain acceptable reconciliation performance, compliance, user satisfaction, and help develop greater efficiencies to identify charge enhancement opportunities. This position will determine the need for claims to be adjudicated with no further review, review records, or facilitate an onsite audit at the hospital. Develops and documents hospital claims review and audit policies. Collaborates with Luminis Health facilities to provide clinical policy representation at meetings to ensure that decisions, which affect claim processing, are appropriate and will result in cost-effective, efficient, and accurate claims payment. The analyst will investigate provider aberrant/fraudulent billing practices utilizing paid claim data and review medical records. Provides education to employees and provider offices as needed to understand correct claim coding, use of CPT, ICD9, ICD-10 HCPCS, etc.
Required Skills & Experience
Bachelors Degree in related field (accounting, finance, business, or Healthcare related)
5-7 years of experience supporting Revenue Cycle and Clinical Systems
Knowledge of the FULL life cycle of Revenue Cycle
Great Communication skills
Understanding of Federal Reimbursement guidelines
Nice to Have Skills & Experience
Certification as a Registered Health Information Administrator (RHIA) is preferred
Certified Professional Coder (CPC), Certified Coding Specialist (CCS), or Certified Outpatient Coder (COC) certification preferred.
Healthcare Financial Management Association (HFMA) Certification preferred
National Association of Healthcare Revenue Integrity (NAHRI) certification preferred
Experience with Crainware or RevMax
Benefit packages for this role will start on the 1st day of employment and include medical, dental, and vision insurance, as well as HSA, FSA, and DCFSA account options, and 401k retirement account access with employer matching. Employees in this role are also entitled to paid sick leave and/or other paid time off as provided by applicable law.