Baptist Memorial Healthcare
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at Baptist Memorial Healthcare
- Position Code
- Regular Full-Time
- HS Central Bus Off
Overview and Responsibilities
Reporting to the Revenue Integrity Director, the Coordinator plays an important role in a high-profile group tasked with improving revenue results by taking a global view of clinical and financial processes, functions and interdependencies from the provision of patient care to final bill generation. Responsible for working with moderately complex clinical departments and practices, which requires strong interpersonal and communication skills, well-developed analytic and organizational skills, and the ability to influence others to meet deadlines.
- Supervision, oversight, and direction to revenue integrity team, work queues and special projects necessary to support Revenue Integrity functions.
- Reviews, analyzes and resolves accounts that have failed coding and charging related claim edits, including medical necessity, National Correct Coding Initiative (NCCI), Medicare Outpatient Code Editor (OCE), Medically Unnecessary Edits (MUE), and other exceptions requiring clinical/coding expertise.
- Works closely with Revenue Cycle teams to resolve rejections and denials.
- Analyzes accounts flagged for potential missing charges; interacts with clinical departments to obtain additional information needed to properly bill accounts based on clinical documentation.
- Analyzes billing error and denial data to resolve accounts and identify root causes. Executes on work plans to correct identified deficiencies.
- Reviews, researches, and documents trends with a focus on identifying charging and documentation opportunities. Supports Revenue Integrity Liaisons in providing guidance, communication and education on correct charge capture, coding and billing processes to clinical departments.
- Assesses the accuracy of all charging vehicles, including clinical systems and dictionaries, encounter forms and other charge documents. Executes on charge reconciliation protocols to ensure revenue protection and minimize late charges, working closely with all clinical departments and with Central Business Office.
- Researches and evaluates government regulations and third-party payor requirements to ensure accurate error resolution and appropriate billing.
Required Knowledge, skills and Abilities:
- Must have significant revenue code, CPT and HCPCS coding knowledge.
- Solid understanding of institutional and professional claim forms fields and values, multiple reimbursement systems including IPPS, OPPS, and Fee Schedule.
- Excellent interpersonal and communication skills to positively interact with a variety of hospital personnel, including administrative and management staff.
- Highly skilled experience and knowledge of Windows-based software required, including but not limited to Microsoft Windows, Outlook, Excel and Access.
- Possess effective oral and written skills, including advanced presentation skills.
- Well-developed research skills.
- Ability to interpret and implement regulatory standards.
- Working knowledge of multiple healthcare applications; Epic experience highly desired
- Knowledge of accurate sources for updating all applicable code sets (CPT/HCPCS, ICD-9, etc.) inclusive of associated edits such as NCCI.
- Excellent organizational and project management skills.
- Possess effective time management skills to permit handling of large workload.
- Bachelor’s Degree or equivalent work experience.
- Preferred Bachelor’s degree in Health Information Management or nursing
- At least 3 years minimum experience in healthcare finance, or CDM/Revenue integrity.
- Advance knowledge of EPIC charge description master (CDM), pricing, charge structure and processes.
- Two - Three years of experience n the healthcare industry with a working knowledge of hospital or physicians revenue cycle functions.
- Up to date working knowledge of Medicare billing regulations
- Up to date working knowledge of medical coding rules and regulations
- Working knowledge of current Medicare, Medicaid and other regulatory billing guidelines and requirements
- Understanding of Industry specific terminology
- Detailed knowledge of revenue cycle work streams and revenue flow
- Revenue cycle process management
- Significant systems expertise
- Comprehensive experience with facility and professional billing requirements
- Dual Hospital and Professional coding certifications preferred (CPC, CCP-H, CCS, CCSP)
- EPIC CDM certification or within one year.
- Preferred: RHIT credentials.
Conditions of Employment:
Baptist Memorial Healthcare Corporation Revenue Integrity Coordinator manages a significant volume of business and operations across multiple locations. Work priorities shift in response to fluctuating demands. Full time schedules are assumed to be at least 40 hours, however, incumbents are expected to remain flexible to accommodate the unit's goals and mission, and to work beyond their normal schedule when necessary. While this role will primarily be based in an office or home environment, there will be exposure to clinical areas and operations. Ability to provide transportation to travel as required to accomplish the goals of the unit.