RESPONSIBILITIES
I. JOB SUMMARY/RESPONSIBILITIES:
• Responsible for auditing the charge capture process to ensure that all valid charges are captured in the billing process in a timely manner.
• Identifies charge compliance issues and root causes of noncompliance. Ensurescorrection of such issues and develops changes to workflow processes to ensure that such issues are prevented in the future.
• Monitors functions and activities to safeguard The Queen's Health Systems (QHS) against exposure to penalties and fines by ensuring healthcare services are billed accurately and properly at all times.
• Provides education and training to departmental staff to ensure understanding and compliance to correct charging procedures.
II. TYPICAL PHYSICAL DEMANDS:
• Essential: Sitting, finger dexterity, seeing, hearing, speaking, repetitive arm/hand motions, static gripping of an object for prolonged periods, frequent gripping of an object.
• Occasional: Standing, twisting body, lifting and carrying usual weights of 15 to 30 pounds, reaching above, at, and below shoulder level.
• Operates personal computer, calculator, telephone, fax and printer.
III. TYPICAL WORKING CONDITIONS:
• Not substantially subjected to adverse environmental conditions.
IV. MINIMUM QUALIFICATIONS:
A. EDUCATION/CERTIFICATION AND LICENSURE:
• Bachelor's degree in Business Administration, Finance or Health Care Administration or related field; or four (4) years progressive experience in Revenue Cycle or Finance may be substituted for the educational requirement.
• Master's degree in a related field preferred.
B. EXPERIENCE:
• In addition to the education requirement, three (3) years experience in two (2) or more areas of the revenue cycle process to include, but not be limited to patient access, scheduling, charge capture, CDM maintenance, claims submission and follow-up, payment posting, collections, claims adjudication, third party payer contracts, government reimbursement and policies, compliance, net revenue and/or profitability analyses, preferably in an acute care facility.
• Experience in a lead or supervisory role.
• Experience to demonstrate the following:
o Working knowledge of CPT/HCPCS and revenue code assignment and ICD-9 coding.
o Working knowledge of charge master principles and the relationship to coding, billing and compliance in a hospital setting.
o Working knowledge of health care delivery systems, including contracting and financial analysis.
o Knowledge of reimbursement regulations, including Medicare/Medicaid program requirements, and medical terminology.
o Ability to develop and implement education/training programs and activities.
o Proficiency in computer applications such as Word and Excel, and computer-based hospital billing/records applications with preference given to experience with Epic systems.
o Knowledge of Crystal Report Writer.
Equal Opportunity Employer/Disability/Vet