Bargaining Unit: None Rate of Pay: $38.00 / HR + DOE
SUMMARY: Performs and reviews regular audits to support the maintenance and enhancement of Tahoe Forest Health District (TFHD) charge capture and overall billing functions. In addition, this position will explore potential charge capture workflow enhancements and work queue management, measuring late charge impact to billing according to industry standards, payer contracts and denial trends. This role is also involved in the design and implementation of proper data extraction and analytics processes across departments and service lines, including finance and revenue generating departments.
This position maximizes charge efficiency through: (1) Monitoring revenue cycle processes and staff functions; (2) Supporting TFHD revenue capture and integrity through evaluating the accuracy of charge capture and billing functions, and staying apprised of payer and/or regulatory updates; (3) Assisting in the design and implementation of charge capture/billing workflow improvements.
ESSENTIAL DUTIES AND RESPONSIBILITIES: include the following:
Works with the appropriate staff to monitor the hospital charge capture process by entering charge capture data into tracking tools, and analyzes audit findings for improvement opportunities.
Arranges audit timelines with individual departments and external business partners, and ensures each party meets set deadlines and/or standards.
Conducts routine quality control audits of random sample cases; reports practices requiring corrective action to departmental leadership.
Reviews billing workflows and work queues and works with the appropriate teams to adjust billing system to detect errors and/or omissions.
Assists in overseeing the charge capture system to promote its accuracy and integrity across revenue-generating departments.
Prepares departmental summaries that pinpoint root causes of charge/billing errors or charge posting delays and conceptualize process changes for service line leaders; uses hospital denials data to support findings.
Revisits departments and conducts further review to gauge the efficacy of charge capture and other process flow recommendations.
Utilizes available reports and dashboards within Electronic Health Record (EHR) to monitor the revenue cycle and collaborate with department leaders to create additional training as appropriate.
Works with EHR partners to develop standard and customized reports to support revenue cycle.
Works with decision making tools to analyze revenue cycle health for the district.
Fine-tunes and maintains current charge capture methodologies and tools with the finance department.
Participates in charge master (CDM) maintenance efforts by reviewing whether charges accurately reflect provided services/supplies.
Reviews changes in pricing, Current Procedural Terminology (CPT) codes, Healthcare Common Procedure Coding System (HCPCS) codes, and revenue codes for accuracy and compliance.
Recommends new categories for CDM inclusion based on audit findings and solicited staff suggestions.
Demonstrates System Values in performance and behavior.
Complies with System policies and procedures.
Other duties as may be assigned.
EDUCATION AND EXPERIENCE: Required: Bachelor’s degree (B.A.) in business or related field from four-year college or university; and five years of revenue cycle experience and/or training; or equivalent combination of education and experience. Preferred: Ten+ years of revenue cycle experience.
LICENSES, CERTIFICATIONS: Preferred: Epic certification in one or more Revenue Cycle modules.
OTHER EXPERIENCE/QUALIFICATIONS: Minimum: Working knowledge with a technical expertise in all aspects of Revenue Cycle including, charges, documentation, revenue. Must be comfortable with face-to-face interactions with physicians and/or other clinical staff.
In-depth knowledge of compliance regulations as they relate to documentation, coding, and billing requirements.
Thorough understanding of revenue integrity processes and their impact throughout the revenue cycle.
Adept analytical skills and a proven ability to develop effective solutions for complex business challenges.
Strong leadership skills; able to work both independently and as part of a team.
Exceptional verbal, interpersonal, and written communication skills.
Effective at adjusting to change, prioritizing duties, and handling stress.
Preferred: Three to five years’ experience in charge capture or charge master review, medical record review, and claims auditing, and in working with regulatory and policy compliance issues related to federal and state programs. Certification in Epic a plus.
COMPUTER/BUSINESS SKILLS: Extensive knowledge and ability to use word processing and other Microsoft Office programs.