HOURLY RANGE: $30.68 - $41.57
DISTINGUISHING FEATURES OF THE CLASS: The work involves managing the processes related to verifying proper documentation for revenue capture activities at the Erie County Medical Center Corporation. The incumbent performs a variety of activities related to revenue integrity including, but not limited to, conducting internal reviews of medical record and billing documentation, verifying charges are captured and preventing revenue leakage and maximizing potential revenue through process redesign and improvement along with education, communications and partnership with operational leaders. The work is performed under the general supervision of the Manager of Revenue Capture and Integrity. Supervision is not a function of this position. Does related work as required.
TYPICAL WORK ACTIVITIES:
Perform daily maintenance of the charge master to review with appropriate revenue code, International Classification of Diseases (ICD-10-CM and ICD-10-PCS), Healthcare Common Procedure Coding System (HCPCS), American Medical Association (AMA)- Current Procedural Terminology (CPT) and pricing in accordance with AMA, Centers for Medicare and Medicaid (CMS) and other payor requirements in a timely manner;
Develops and performs internal reviews to confirm provider documentation verifies those services rendered and billed;
Verifies charges are compliant with applicable laws, regulations and payer guidelines; validates data file transmission of charges;
Serves as a liaison between Revenue Cycle operations, Health Information Management, Finance and Information Technology departments as it relates to revenue capture documentation and reconciliation;
Assists the Revenue Integrity function in performing related internal reviews related to charging, coding and billing for accurate revenue capture to promote compliance, reduce denials and optimize reimbursement;
Investigates new revenue capture opportunities due to coding changes;
Verifies accurate cross-walk of charge master details with underlying clinical systems used for revenue capture and clinical documentation;
Assists departmental management with electronic medical record (EMR) functionality and development of documentation templates and makes EMR functionality, documentation, coding and billing process improvement recommendations;
Provides guidance to and supports clinical department needs on questions, processes, status and planned changes to coding and billing protocols and conventions of affected departments and escalates to management when needed;
Performs concurrent and retrospective audits of patient records to verify proper charging of services for compliance and proper reimbursement of claims to maintain revenue integrity;
Provides support to Patient Financial Services in resolving issues with procedural edits and other general information and assists in the reduction of accounts receivables by identifying charge and coding issues;
Complies with applicable federal and state regulatory guidelines, including Health Information Portability and Accountability Act of 1996 (HIPAA) privacy standards and established departmental policies, procedures and objectives;
Attends and participates in office meetings to review problems and issues and to review, identify and develop process improvements.
FULL PERFORMANCE KNOWLEDGES, SKILLS, ABILITIES AND PERSONAL CHARACTERISTICS: Thorough knowledge of the principles and practices related to charge description master and its related processes such as billing and reimbursement; good knowledge of applicable laws, rules, regulations and accreditation standards as they related to the charge description master and related processes; working knowledge of medical terminology; thorough knowledge of industry coding mechanisms, and their current versions, such as International Classification of Diseases, AMA-CPT and CMS HCPCS; good knowledge of third-party reimbursement rates and guidelines for processing reimbursements; ability to review posted charges for verifying accuracy and timeliness; ability to summarize findings and prepare related reports; ability to maintain charge description master; ability to develop educational materials and train others on the charge description master and related components; ability to communicate effectively, both orally and in writing; ability to establish and maintain effective working relationships with a diverse constituency; ability to utilize a variety of electronic software applications including Microsoft Office Suite; sound professional judgment; capable of performing the essential functions of the position with or without reasonable accommodation.
MINIMUM QUALIFICATIONS:
SPECIAL REQUIREMENTS:
Active status as a Registered Health Information Administrator (RHIA) by the American Health Information Management Association (AHIMA) at time of appointment and maintenance throughout duration of appointment; or:
Active status as a Registered Health Information Technician (RHIT) by the American Health Information Management Association (AHIMA) at time of appointment and maintenance throughout duration of appointment; or:
Possession of Certified Coding Specialist (CCS) certification as issued by the American Health Information Management Association (AHIMA) at time of appointment and maintenance throughout duration of appointment; or:
Possession of Certified Professional Coder (CPC) certification as issued by the American Association of Professional Coders (AAPC) at time of appointment and maintenance throughout duration of appointment; or:
If appointed prior to July 2023, possession of a Certified Medical Coding (CMC) certification as issued by Practice Management Institute at time of appointment and maintenance throughout duration of appointment.
NOTE 2*: Your degree must have been awarded by a college or university accredited by a regional, national, or specialized agency recognized as an accrediting agency by the U.S. Department of Education/U.S. Secretary of Education. If your degree was awarded by an educational institution outside the United States and its territories, you must provide independent verification of equivalency. A list of acceptable companies who provide this service can be found on the Internet at http://www.cs.ny.gov/jobseeker/degrees.cfm. You must pay the required evaluation fee.
NOTE 3: Verifiable part-time and/or volunteer experience will be pro-rated toward meeting full-time experience requirements.
Equal Opportunity Employer
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