- Understands Medicare, Medicaid, and managed care billing requirements and reimbursement methodologies and applies knowledge to identify, quantify, and address missing/incorrect charges.
- Partners with assigned clinical departments to ensure complete, correct, and compliant charge capture: Identifies root causes of missing/incorrect charges.
- Quantifies financial benefit of missing/incorrect charges and of proposed improvements.
- Works with clinical departments, coding, patient financial services, registration/admitting, managed care, finance, corporate compliance, IT and outside vendors to design and implement improvements.
- Structures and conducts analyses to quantify the financial impact of current processes and proposed improvements.
- Has joint ownership with the assigned clinical department managers for completeness, accuracy, ease of use, and maintenance of the department charge master.
- Has joint ownership with the assigned clinical department managers for performance on the charge capture dashboard metrics.
- Reviews sources of lost revenue monthly to identify trends in charge entry, billing, coding or contracting practices that are related to charge capture. Then works with the appropriate department(s) to address the issue. Escalates compliance concerns to manager and corporate integrity appropriately.
- Provides backup for the Charge Capture Analyst by entering identified missing charges into billing system. Developing, maintaining and distributing organizational and clinical department dashboards for the charge capture initiative. Managing the Charge Error Edit Report. Works on other projects, as assigned.
Additional Functions:. Assist in the development of educational programs and provide training sessions on revenue and charging. Assist in the development of resources for researching issues for Charge Capture team as well as clinical managers. Stay abreast of changing rules and regulations related to billing.
- Bachelor degree and 3 years' experience in a similar role as a consultant or in a hospital, or at least 10 years of equivalent experience in Billing and Coding with progressive advancement.
- Strong verbal and written communications.
- Strong interpersonal skills.
- Proficient knowledge of MS Office including Excel, PowerPoint, Word and Outlook.
- Proficient and experienced using multiple financial systems.
- Certification in Medical Billing and Coding.