Revenue Assurance Specialist IV

Job Summary:

Promotes accurate assignment of system codes for billing and revenue processes by translating moderately complex charge throughput guidelines and services capture code reviews. Reviews include codes, pricing, and data integrity impacting throughput for accuracy and completeness in alignment with coding and billing guidelines. Performs account reviews and maintenance of system codes to ensure codes are updated, compliant, and accurately reflect policy and regulatory changes. Executes monitoring activities and process improvements by analyzing findings from monitoring activities, identifying deficiencies and/or compliance issues, partnering with other departments to resolve deficiencies and/or compliance issues, and implementing corrective action plans. Provides guidance to the department, physicians, and practitioners by consulting on moderately complex coding/billing issues, charging inquiries, and relevant policies and regulations.

Essential Responsibilities:

• Promotes learning in others by proactively providing and/or developing information, resources, advice, and expertise with coworkers and members; builds relationships with cross-functional/external stakeholders and customers. Listens to, seeks, and addresses performance feedback; proactively provides actionable feedback to others and to managers. Pursues self-development; creates and executes plans to capitalize on strengths and develop weaknesses; leads by influencing others through technical explanations and examples and provides options and recommendations. Adopts new responsibilities; adapts to and learns from change, challenges, and feedback; demonstrates flexibility in approaches to work; champions change and helps others adapt to new tasks and processes. Facilitates team collaboration to support a business outcome.
• Completes work assignments autonomously and supports business-specific projects by applying expertise in subject area and business knowledge to generate creative solutions; encourages team members to adapt to and follow all procedures and policies. Collaborates cross-functionally and/or externally to achieve effective business decisions; provides recommendations and solves complex problems; escalates high-priority issues or risks, as appropriate; monitors progress and results. Supports the development of work plans to meet business priorities and deadlines; identifies resources to accomplish priorities and deadlines. Identifies, speaks up, and capitalizes on improvement opportunities across teams; uses influence to guide others and engages stakeholders to achieve appropriate solutions.
• Promotes accurate assignment of system codes for billing and revenue processes by: translating moderately complex charge throughput guidelines and services into codes to facilitate accurate billing of services provided; reviewing codes configured in the system for proper alignment with charge throughput and coding guidelines and services; and independently analyzing regional and national policies and reimbursement practices to provide recommendations for charge integrity updates.
• Performs routine review and maintenance of system codes by: performing a regular review (e.g., quarterly, annually) of coding records to ensure codes are updated, compliant, and accurately reflect policy and regulatory changes; conducting pre- and post-implementation assessments of automated and manual charge capture for quality and accuracy; analyzing moderately complex billing issues related to charges/codes and proposing and implementing action plans to resolve charge capture issues; and contributing to the maintenance of all Current Procedural Terminology (CPT)/ Healthcare Common Procedure Coding System (HCPCS) codes, descriptions, revenue codes, Relative Value Units (RVU) information, and generic codes to assist in the understanding of fee schedule implications.
• Serves as a billing and coding expert for the department by: providing guidance to other departments, physicians, and practitioners on moderately complex coding/billing issues, charge inquiries, and relevant policies and regulations; and participating in and supporting trainings to improve revenue cycle processes and outcomes.
• Executes monitoring activities and process improvements by: independently performing tasks that support monitoring activities of the region(s) documentation, charge capture, coding, billing, and/or compliance activities; recording findings in accordance with relevant policies/procedures to ensure complete and consistent data integrity, partnering with other departments to resolve moderately complex deficiencies and/or compliance issues identified through monitoring activities; communicating results of monitoring activities to senior team members and/or department leaders; and implementing corrective action plans resulting from monitoring activities.