-Manages the Hospital’s Revenue Cycle Process Improvement initiatives through close interaction with leadership and personnel in the Patient Business Office, Reimbursement & Managed Care Dept, Patient Scheduling, Admissions and Registration, Health Information Management, and various Clinical Operating Departments.
-Manages and maintains functionality of the Hospital’s charge description master (CDM) through:
Annual CPT and HCPCS level II billing and CDM coding revision; Annual reimbursement revisions (APC’s, CPT codes).
-Educates hospital personnel regarding all aspects of the revenue cycle including but limited to appropriate CDM coding and Charging
LIST THE ESSENTIAL FUNCTIONS PERFORMED BY THIS POSITION
Works with the all departments which impact the hospital’s ability to develop and document processes which facilitate clean automated billing of hospital claims. This includes identification of people, process, and technology issues, development of appropriate solutions, participation in the roll-out of the process improvement solutions, and ongoing monitoring. Will participate on existing teams and initiate and lead project teams, as needed.
Works with Scheduling, Registration, Clinical Departments, Health Information Management, and the Business Office to ensure all staff which impact the revenue cycle receive all needed education and competency is assessed. Assists in the preparation of educational material and provides education as needed.
Reviews and implements changes relative to annual CPT/HCPCS level II/APC, billing and CDM coding updates, as they relate to all payers, including the annual Medicare outpatient billing and coding updates.
Works directly with clinical operating departments, Managed Care & Reimbursement, Supply Chain and business office personnel to ensure the hospital receives all reimbursement to which it is entitled through appropriate charging and coding of patient claims.
Assists other departments in conducting department-specific periodic audits of their charging practices to ensure accurate and timely charging.
Is responsible for the content and maintenance of the hospital’s Charge Description Master (CDM), including determination, compilation and analysis of hospital rates.
Directly responsible for making recommendations for all hospital rates, including cost justifications and profitability analysis.
Acts as a liaison to the hospital’s Corporate Compliance Department for patient accounting compliance issues.
Directly responsible for the supervision of the Data Quality Control Coordinator and CDM Specialist
Works with IT to build/modify/update department charge screens for changes in processes which may or may not be related to implementation of new ancillary clinical documentation systems. Validate that charges are passing to patient accounting system.
Member of the Financial Oversight Committee, Corporate Compliance & Ethics Committee Business Affinity Group and other committees as appropriate.
Performs other duties as assigned.
EDUCATION & TRAINING:
Bachelors Degree in Business, Management, Finance, Health Care Administration, or Accounting required. Billing compliance and coverage guidelines working knowledge required. Working knowledge of financial micro computer applications and software required. Education in developing and providing training preferred (This position involves teaching in a large part).
Minimum five to ten years hospital revenue cycle experience. Physician billing/reimbursement experience helpful.
Demonstrated expertise in patient accounting management and billing systems including their uses, capabilities and limitations.
Experience with coding (CPT, diagnosis, revenue and insurance codes, etc.), and a working knowledge of billing regulations, including, but not limited to Medicare IP PPS and OPPS, Medicaid and commercial billing guidelines, a must.
Strong understanding of Hospital Charging and rate structure.
Financial data modeling and analysis a plus.
LICENSE & CERTIFICATION:
Certified Professional Medical Coder preferred (but not required)