Artificial Intelligence (AI), Auditing, Billing, Charge Capture, Clinical Medicine, Clinical Support, Communication Skills, Compensation and Benefits, Cost Control, Epic Systems, Establish Priorities, Finance, Financial Analysis, Financial Compliance, Government, Healthcare, Healthcare Administration, Interpersonal Skills, Leadership, Maintain Compliance, Medical Coding, Microsoft Excel, Microsoft PowerPoint, Network Routers, Operational Support, Policy Implementation, Problem Solving Skills, Reconciliation, Regulations, Regulatory Compliance, Reimbursement, Standards of Care, Team Player, Telehealth, Time Management
Why ThedaCare?
Living A Life Inspired!
Our new vision at ThedaCare is bold, ambitious, and ignited by a shared passion to provide outstanding care. We are inspired to reinvent health care by becoming a proactive partner in health, enriching the lives of all and creating value in everything we do. Each of us are called to take action in delivering higher standards of care, lower costs and a healthier future for our patients, our families, our communities and our world.
At ThedaCare, our team members are empowered to be the catalyst of change through our values of compassion, excellence, leadership, innovation, and agility. A career means much more than excellent compensation and benefits. Our team members are supported by continued opportunities for learning and development, accessible and transparent leadership, and a commitment to work/life balance. If you're interested in joining a health care system that is changing the face of care and well-being in our community, we encourage you to explore a future with ThedaCare.
Benefits, with a whole-person approach to wellness -
Lifestyle Engagement
e.g. health coaches, relaxation rooms, health focused apps (Wonder, Ripple), mental health support
Access & Affordability
e.g. minimal or zero copays, team member cost sharing premiums, daycare
About ThedaCare!
Summary :
The Physician Revenue and Billing Compliance Coordinator partners with clinical, revenue cycle, compliance and finance departments to effectively monitor, communicate, and implement compliant billing practices. This role is the subject matter expert in regulatory and payer policies and is responsible to implement regulatory and payer policy changes, investigate billing requirements needed to support new clinical services, manage and mitigate escalated payer denials, perform timely resolution of payer audits, and design sustainable charge capture and reconciliation protocols.
Job Description:
JOB RESPONSIBILITIES:
- Researches and provides billing guidance to support operational leaders in the implementation of new services and charge codes.
- Identifies opportunities to ensure accurate and comprehensive charge capture.
- Monitors, communicates and assists all functional departments with the implementation of payer and regulatory policy changes.
- Understands, monitors and effectively partners with clinical and revenue cycle leaders to ensure accurate telehealth billing and reimbursement.
- Collaborates with compliance and revenue cycle functional areas to audit professional claim accuracy.
- Monitors and resolves charge router errors.
- Monitors and partners with clinical leaders to ensure charge reconciliation is maintained.
- Monitors Revenue Cycle AI solutions to ensure compliance and accuracy.
- Researches regulatory and payer policies to assist in the appeal process of global denial trends.
- Manages payer denial trends to ensure timely resolution or escalation.
- Monitors and ensures timely resolution of government payer audits. Collaborates with compliance team to communicate volumes and escalations.
- Owns payer portal administration.
- Other duties as assigned.
QUALIFICATIONS:
- Minimum 5 years of progressive experience in revenue cycle or healthcare compliance with 3 years specific to physician billing and coding and a nationally recognized physician coding certification. Preferred; Bachelor's degree in HIM, Healthcare Administration, Business, Finance, or a related field.
- Strong understanding of billing, coding, regulatory and payor policies including telehealth billing requirements across commercial and government payers.
- A collaborative and proactive problem-solver with exceptional communication, presentation and interpersonal skills.
- Excellent investigational skills.
- Proven ability to work independently.
- Strong Excel and PowerPoint skills.
- Demonstrates excellent time management with the ability to prioritize and thrive in a fast paced, growth environment.
- Knowledge of healthcare regulations and compliance requirements.
- Required: Experience with Epic practice management system.
QUALITIES:
Ability to support, advance and live our mission and evidence of such:
Mission - Our reason for Being - To advance the health of our communities through excellence and discovery, inspiring each person to live their unique best life
Ability to support, advance and work toward our vision and evidence of such.
Vision - Who we Aspire to be - To be your trusted partner, transforming health care for everyone every day
Commitment to and evidence of demonstrating our guiding principles.
Scheduled Weekly Hours:
40
Scheduled FTE:
1
Location:
CIN 3 Neenah Center - Appleton,Wisconsin
Overtime Exempt:
Yes
Worker Shift Details:
Days