The purpose of this position is to maintain the daily operations of the Revenue Integrity Team. The primary objective is to support the overall integrity of charge capture to ensure optimal, accurate and compliant charge practices, which includes collaboration with clinical departments to ensure applicable education, training and support related to charge audit and charge-related processes are effective.
Duty 1: Provide direct oversight to the Revenue Integrity Team (including Charge Auditors, Charge Validation Specialist) and related functions with the primary objective to support the integrity of charge capture to ensure compliance with applicable regulatory standards. Effectively communicate and solicit input from team and other impacted areas to promote a collaborative and innovative team environment, translates BVHS's Mission, Vision and Values into front-line action. Maintain effective connectivity and collaboration between all members of the team, including onsite and remote associates.
Duty 2: Perform supervisory administrative support functions including but not limited to: assist in the recruiting and hiring process, training & education of associates, coordinate staff schedules, payroll, completion of associate performance evaluations, recognition and reward, disciplinary follow up as appropriate, monitor adherence to established quality/productivity standards and department metrics, assist in the development and monitor completion of competencies and organization mandatory requirements, etc.
Duty 3: Regularly perform or coordinate the completion of quality reviews of the Charge Validation team to ensure the overall integrity of accurate and optimal charge capture appropriately supported by clinical documentation. Identify opportunities for improvement and document results and implement action items to resolve issues.
Duty 4: Monitor results of internal audits performed by Charge Audit team and support resolution of identified issues, including assisting facilitation with clinical departments, PFS, Compliance and other impacted areas to resolve and mitigate future recurrence of issues.
Duty 5: Provide support and guidance to Corporate Compliance Department in audits or initiatives related to charging processes. This may include participating in charge audits in response to an investigation or potential compliance risk, conducting charge-related research, assisting to develop an audit tool or interacting with third party consultants conducting a compliance review.
Duty 6: Develop or coordinate the development of educational materials and tools necessary to support clinical departments charge processes. Provide or coordinate training and education, as needed, to clinical departments or areas involved/impacted by the charging process.
Duty 7: Provide support to maintain the Cerner Charge Services solution, and/or other related solutions that impact charge flow, reporting or functions within the scope of the Revenue Integrity section or Revenue Cycle division. Collaborate with Revenue Cycle Analyst as needed to support system modifications and optimization. Remain proficient and competent in system. Coordinates and/or participates in system testing as a result of upgrades, changes, enhancements, new application implementations, etc. that may impact charge capture and/or charge data flow.
Duty 8: Regularly attend and actively participate in in-services, organizational meetings and continuing education programs as offered in order to remain current with organizational and industry changes and best practice. Communicate and disseminate information to other departments as applicable. Provide training and educational support/opportunities to the Revenue Integrity Team.
Duty 9: Assist in the development of revenue integrity-related departmental, division and/or organizational policies and procedures for recommendation and approval, as necessary.
Duty 10: Demonstrate superior understanding of federal, state and third party charging guidelines to identify required changes to CDM and potential reimbursement impacts. Support Charge Audit Team to implement revisions to charge/billing regulations, including annual IPPS and OPPS revisions,
A Bachelor's degree in a related field including but not limited to, Health Information Management (HIM) or 4+ years' experience from which comparable knowledge and abilities have been acquired.
CCA or CPC certification required or achieved within 9 months of hire date.
Medical terminology and Anatomy & Physiology required.
Knowledge of ICD10/DRG/Coding Clinic, CPT/HCPCS/APC/CPT Assistant/Modifiers required.
Knowledgeable of revenue cycle workflows, including information and charge workflows throughout the health system required.
Technical aptitude, proven proficiency with computers and commonly used software applications, including MS Office Suite, internet, electronic health records.
A valid driver's license is required (if you do not have a valid Ohio driver's license you must obtain one within one year of your residency in the state) and you must also meet BVHS's company fleet policy requirements.
Strong problem solving and analytical skills, ability to manage project tasks and timelines. Self-directed.
Must possess positive service-oriented and interpersonal skills; strong communication, including written and verbal presentation skills, required. Ability to manage controversial situations in a professional way and demonstrate sound judgment and reasoning skills
Certification in HIM (RHIA or RHIT) preferred.
Other relevant certifications, including CANPC or CPB preferred.
Knowledge of Clinical Documentation Improvement concepts preferred.
This position requires a full range of body motion with intermittent activities in sitting, walking, lifting, bending, squatting, climbing, kneeling, twisting and standing. The associate must be able to lift 50 pounds or more and reach work above the shoulders. The individual must have excellent eye/hand coordination with the ability to grasp, push and pull, fine finger dexterity and manipulation. This position requires corrected vision and hearing in the normal range. The associate must have excellent verbal skills to communicate with patients, physicians, and co-workers.
This position is classified at risk for possible occupational exposure to bloodborne pathogens (HBV, HIV, etc.)