REVENUE INTEGRITY SPECIALIST

  • Campbell County Health
  • Gillette, WY
  • Jul 26, 2021
Full Time

Job Description

Maintains and ensures chargemaster is accurate and complete. Processes all charge requests from departments to ensure pricing, CPT/HCPCS codes, revenue codes, and statistical data is correct. Works closely with all departments to ensure their chargemasters are kept current with coding and pricing changes along with regulatory compliance as to proper charge capture. Audits charge review/claim edits to support compliance with CCI, OCE, MUE claim edits and LCD & NCD billing rules, while maximizing reimbursement. Resolves billing issues and provides coverage guidelines for billable services to reduce or prevent future claim denials. Works on operational optimization tools and is responsible for root cause analytics along with audits to help identify opportunities, issues, and process improvement within the clinical charge capture or billing workflows. Works through revenue cycle leadership to communicate training and optimization needs to clinical leadership, chargemaster committee, compliance, and related areas. Charge master maintenance. Ensures CCH is receiving reimbursement according to payer contracts. Assists with denial management efforts. PRIMARY JOB DUTIES Responsible for ongoing charge master maintenance including pricing updates, creating charges, and ensuring charges generate properly in all systems across organization. Works with revenue cycle leadership, chargemaster team, and clinical departments to support optimal charge capture for services provided Works with departments to ensure proper charge capture. Performs claims reviews through running of various charge reconciliation reports and ensuring that record documentation supports charges captured. Establishes effective relationships with other CCH departments; builds and maintains effective business partner relationships Provides exceptional customer service to internal and external customers Frequently interacts with other finance staff, IT staff, PFS Department, HIM Department, Patient Access Department, and management to ensure revenue integrity goals are achieved Performs related duties as assigned Maintains up to date knowledge of payer policies and government regulations to support compliant and accurate billing processes in addition to knowledge of CPT and HCPCS CCI coding/ billing guidelines. Performs root-cause analysis for high volume edits to reduce the incidence of non-billable charges. Works with IT to correct any technical error causing incorrect charge routing and clinical departments on missed charges. Monitors coding and billing changes that may affect revenue and assesses contract terms and methodologies to ensure maximum reimbursement Maintains confidentiality of all personnel and patient care and relations information. Actively participates in Strategic Plans for the department and organization. Actively participates in Customer/Guest Relations and Mandatory Education programs. Follows hospital and departmental policies and procedures. Must be free from governmental sanctions involving health care and/or financial practices. Complies with the hospital’s Corporate Compliance Program including, but not limited to, the Code of Conduct, laws and regulations. JOB SPECIFICATIONS Education: High school graduate. Certifications required: See Cardiopulmonary Resuscitation Certification Policy and Certifications/Education Requirements Policy Experience: Organizational Astuteness, Managing Processes, Process Improvement, Reporting Skills, Change Management, Coaching, Client Relationships, Supports Innovation, Developing Standards, Hiring, Administrative Writing Skills. Essential Technical/Motor Skills: Computer skills. Computer literate with good keyboarding skills. Typing 40 WPM. Eye-hand coordination, manual and finger dexterity. Ability to run a copier. Ability to answer phones. Ability to learn and utilize alphabetical and terminal digit filing systems. Interpersonal Skills: Excellent interaction with visitors, patients, coworkers, medical staff, outside agencies effectively and courteously. Corresponds effectively with outside agencies. Essential Physical Requirements: Ability to bend, lift, pull, sit, and stand for prolonged periods of time. Ability to work in small spaces. Essential Mental Abilities: Attention to detail. Reasoning. Review of requests for appropriate criteria. Ability to interpret and apply federal and state statutes regarding the disclosure of healthcare information. Essential Sensory Requirements: Sufficient vision, hearing, and speech to perform duties. Exposure to Hazards: OSHA CATEGORY III. Identified job duties do not have any anticipation for contact with blood, contaminated body fluids or tissues. Employees working in healthcare facilities have the potential to be exposed to hazardous materials including: Hazardous Chemicals/Drugs, Waste Anesthetic Gases, Radiation, Latex, Biological Hazards, Respiratory Hazards and Ergonomic Hazards. See Hazardous Materials in the Workplace Policy. Hours of Operation: 7:00-5:30 Monday-Friday Regularly attends staff meetings. Completes mandatory education.

Employment Type (feed only)

Full Time