This position supports revenue cycle operations through the set-up, configuration, analysis, monitoring, and maintenance of the system and operational training support.
Essential Duties: Supports clinical areas, new/existing service lines and departments (this includes Revenue Cycle Management) as follows:
- Continually reviews and proactively communicates governmental policy, payer/vendor updates, newsletters and internal Management initiatives to ensure that services provided to patients are captured and billed in compliance with government regulation, contractual obligation, internal policy/standards or business objectives.
- Coordinates, documents, implements, trains and monitors systems and end-users to ensure effective operation of the Revenue Integrity program and business enterprise.
- Acts as a resource for appropriate charges and codes including but not limited to charge tickets and procedures.
- Validates local Medical Review Policy claim denials.
- Performs billing audits.
- Monitors, updates and maintains system master files/tables (Charge Master Data).
- Works in conjunction with Managed Care/Contracting for end of year updates including pricing changes for the Service Catalog (CDM).
- Maintains Soarian Map Sets and Associated Map Sets.
- Assists with revenue cycle system builds and software updates to ensure smooth continued operations.
- Generates reports to perform analysis on data within the Revenue Cycle. Uses independent judgment to write queries that extract the necessary data from the Revenue Cycle software.
- Reviews reports to ensure the integrity of shared computerized billing/reporting systems and makes recommendations for improvements.
- Analyzes reports to determine processing issues/aged accounts and implements procedures for resolution.
- Assist Revenue Cycle departments with Special Projects and various duties as assigned. *This role may encounter Protected Health Information (PHI) as part of regular responsibilities. Employees must abide by all requirements to safely and securely maintain PHI for our patients. Annual training, the Code of Conduct and policies and procedures are in place to address appropriate use of PHI in the workplace.
Bachelor degree preferably in Accounting, Finance, Computer Science, Nursing or Coding, required.
Credentials, Licensure or Certification (i.e. RN, RRT): Coding certification or RN license preferred.
Experience & Knowledge:
'Minimum 5 years' experience in Healthcare Revenue Cycle, Financial Leadership in a Clinical area or Healthcare Industry Compliance program
'PC proficiency in MS Office
' Demonstrated knowledge of claims submission (UB92's and/or HCFA) or receivables management
'Extensive knowledge of hospital outpatient and/or physician revenue capture knowledge
'Knowledge of ICD Diagnosis, ICD Procedure codes, CPT codes and medical terminology
'Notable client service, communication, presentation and relationship building skills
'Ability to function independently and as a team player in a fast-paced environment
'Must have strong written and verbal communication skills.
'Must be detail-oriented and organized, with good analytical and problem solving ability.
'Proficiency with Adobe Acrobat, Soarian or Meditech, and master file maintenance is a major plus.
Nesco Resource is an equal employment opportunity employer and does not discriminate on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, disability, age, or veteran status, or any other legally protected characteristics with respect to employment opportunities.
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