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Job Objective: A brief overview of the position.
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- The position is responsible for performing revenue cycle integrity audits within the Charge Descriptive Master and other revenue cycle charge capture and reconciliation processes
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Reports to
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- Revenue Audit Manager, Director of Payor Relations
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Supervises
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- N/A
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Ages of Patients
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- Neonate/ Infant
- Pediatric
- Adolescent
- Adult
- Geriatric
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Blood Borne Pathogens
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- Minimal/ No Potential
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Qualifications
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Education
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• Preferred: Some College
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Licensure/Certification
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• Required: Currently enrolled in an accredited Coding Certification CPC or CCS program, or set to enroll within 6 months of hire
• Preferred: Successful completion of an accredited Coding Certification CPC or CCS
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Experience
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• Required: Hospital / clinical experience in charge capture, billing processes
• Preferred: Minimum 5 years of hospital / clinical experience in Revenue Cycle processes
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Essential Responsibilities
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1. Demonstrates compliance with Code of Conduct and compliance policies, and takes action to resolve compliance questions or concerns and report suspected violations.
2. Performs audits of all revenue generating departments’ CDM files, conducts departmental interviews to ensure proper recording of transactions and compliance with state and federal coding guidelines relating to the charge capture and billing of services.
3. Provides guidance, communication and education to department and clinic staff on correct charge capture, current charging structure, billing and coding processes by the elimination of duplicate, inactive or non-compliant charges incorporating state and federal guidelines.
4. Prepares and submits audit findings to Revenue Recognition Manager and Director of Payor Relations to review and compile recommendations to management.
5. Assesses the accuracy of charge capture tools (i.e. forms, charge screens, charge stickers and other charge capture tools) and recommends appropriate changes to meet these standards.
6. Reviews facility bill rejection reports to correct, edit or apply appropriate modifiers to charges for compliant billing practices.
7. Examines reports, and makes recommendations regarding deficiencies in controls, duplication of effort, fraud, or lack of compliance to management.
8. Provides assistance to all hospital department charge custodians to assist in completing their department identified bill rejection charges.
9. Maximizes collection through recognition of terms and conditions of EMC’s payor contracts. To present recommendations to Director of Payor Relations regarding terms and conditions and charge increases with consideration of improving payments from third party payors.
10. Acts as liaison between Revenue Recognition team, Charge Master, Payor Relations and PFS to assist revenue generating department directors in the establishment and periodical review of their charge structures and charge rates to be consistent with all regulatory and compliance standards, regional and local market shares and EMC contracts.
11. Assists Revenue Recognition Manager in identifying areas of process improvement, system enhancement andactively engages in a process improvement committee representing Revenue Recognition or the role of Revenue Custodian in any integrated hospital process improvement team.
12. Performs other duties as assigned
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Located in the heart of the Coachella Valley, you have access to resort-style living and world-class amenities throughout Southern California.
