JOB SUMMARY
Under general supervision of the Director, Revenue Cycle manages revenue integrity operations for the hospital and medical group. Provides oversight and leadership for a team responsible for, but not limited to, charge description master (CDM) maintenance, centralized charge control, appropriate revenue and reimbursement, complex claim denial coordination, payer audits and denial prevention. Strives for superior performance by consistently providing a product or service to leadership and staff that is recognized as ultimately contributing to the patient and family experience. Recognizes and demonstrates understanding of patient and family centered care.
PRIMARY JOB RESPONSIBILITIES
Manages and oversees people, systems and processes for revenue integrity, charge control functions, and the performance of revenue integrity metrics.
Implements revenue enhancement initiatives and education.
Manages system enhancements, new programs and facility changes including analysis of impact on net revenue, reimbursement and processes.
Analyzes and displays data in meaningful formats.
Keeps abreast of all current payer medical policies, makes any changes to prevent loss in reimbursement, including but not limited to, Medicare and Medicaid web sites, Payer websites and newsletters for changes impacting charging, coding and billing.
Oversees CDM maintenance and enhancement by analyzing departmental charges, identifying and implementing charge improvements, assisting individual departments with reconciling charge discrepancies, and determine the reimbursement impact of CPT revisions.
Maintains and monitors the process for calculating price recommendations for CFO approval.
Conducts service line and new product analyses and provides information to organizational leadership.
Manages the organizational payer contracting system.
Conduct financial modeling of contracts terms from Third Party Payers.
Develop and maintain scorecards related to Managed Care contracts.
Conducts research on regulatory issues related to Revenue cycle functions as needed.
Assist Revenue Cycle management team with project management related to key projects that have a significant impact across the organization.
Conducts disciplinary discussions and completes required documentation in a respectful, timely manner.
Completes staff performance evaluations within appropriate timeframes.
Completes annual department budget and maintains departmental expenses within budget or provides reason for approved variance.
Works with Memorial Healthcare leadership team related to process improvement and optimization to achieve best practices and positively impact net revenue and cash flow performance.
Will be assigned special projects from the Director, Revenue cycle as needed.
Demonstrates knowledge of and supports hospital mission, vision, value statements, standards, policies and procedures, operating instructions, confidentiality statements, corporate compliance plan, customer service standards, and the code of ethical behavior.
DEPARTMENTAL AND ADDITIONAL JOB RESPONSIBILITIES
- Other duties as assigned
JOB SPECIFICATIONS
EDUCATION
Bachelor's degree in Business, Accounting, health or public administration required.
RHIA, RHIT, CCS, CPC/COC, CPC-H or other coding credentials strongly preferred.
EXPERIENCE
Experience and Proficiency with Microsoft Word, Excel and Outlook required.
Project management experience preferred.
Minimum of Five(5) years of experience in Revenue Cycle/ Healthcare Finance or Billing required.
Experience in Revenue Cycle operations and information systems required.
ESSENTIAL PHYSICAL ABILITIES/MOTOR SKILLS
Able to travel independently throughout all Memorial Healthcare facilities.
Small motor skills required for operating modern computer, office, and telephone equipment as utilized by Memorial Healthcare (MHC).
ESSENTIAL TECHNICAL ABILITIES
- Proficiency using modern office, computer and telephone equipment as used by Memorial Healthcare.
ESSENTIAL MENTAL ABILITIES
Ability to adapt and maintain focus in fast paced, quickly changing or stressful situations.
Ability to read and interpret a variety of documents including, but not limited to policies, operating instructions, white papers, regulations, rules and laws.
ESSENTIAL SENSORY REQUIREMENTS
Able to see for the purpose of reading information received in formats including but not limited to paper, computer, reports, bulletins, updates, manuals.
Able to hear for work-related purposes.
INTERPERSONAL SKILLS
Ability to interact with co-workers, hospital staff, administration, patients, physicians, the public and all internal and external customers in a professional and effective, courteous and tactful manner, at all times, physically, verbally and in all written and electronic communication.
Required to remain calm when adversity is encountered.
Open, honest, and tactful communication skills.
Ability to work as a team member in all activities.
Positive, cooperative and motivated attitude.