Revenue Integrity Liaison

GENERAL SUMMARY:

Serves as the liaison between the revenue cycle management departments and the hospital and ambulatory departments. Responsible for collaborating with department revenue leads and staff to ensure accurate charge capture operations are in place to include daily charge capture, revenue reconciliation and error correction processes. Maintains collaborative relationships with Patient Financial Services, Clinical Departments, and Compliance. Plays an important role 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.

PRINCIPAL JOB FUNCTIONS:

1. *Commits to the mission, vision, beliefs and consistently demonstrates our core values.

2. *Monitors transactions in the charge review work queues and follows up with departments on backlogs, threshold change request and other charge issues.

3. Researches and resolves claim pre-bill edits and pre-bill errors within the assigned queue, including review and correction of the daily assigned DNFB hold claims.

4. Applies NCCI and MUE guidelines to resolve edits appropriately and identify any charging or compliance issues. Coordinates with coding and clinical areas to resolve any identified charging issues.

5. *Responsible for verification and/or correction of billing data for accuracy and completeness by following regulatory requirements and reviewing the medical record.

6. Coordinates findings with hospital departments to ensure missed charges are billed. Collaborates with departments on developing process changes to ensure accurate, compliant and efficient charging practices.

7. *Analyzes the charge review work queues to identifying root causes. Educates clinical staff and department leaders of missed charges or incomplete documentation, which does not support billed charges.

8. *Works with identified clinical and revenue cycle departments to implement compliant process changes.

9. *Meets independently with Directors regarding charging, reconciliation and compliance concerns.

10. *Updates and maintains department charge master as needed including: performing chargemaster maintenance and validating entries; reviewing and assisting with maintenance of chargemaster compliance reports; assisting with other necessary projects to maintain the chargemaster file; and working with clinical areas to update charge master for annual cpt/hcpcs code changes.

11. *Performs patient audits to ensure correct charging and review all external outpatient accounts with external auditors. Leads audit/charge evaluations according to the Manager of Revenue Integrity. Meets with departmental leadership to review findings, documentation standards and recommendations for improvement.

12. *Serves as a liaison between Facility Administration, Department Director, and external auditors regarding charging issues, clinical documentation issues, and revenue opportunities. Builds strong relationships and facilitates productive communication between assigned department Directors, Managers, and staff. Collaborates to develop and implement action plans to resolve charge errors.

13. *Reviews CMS transmittals and Local Coverage Determination (LCD) and assesses impact to Revenue Integrity procedures and implement. Regularly reviews literature to identify enhancement to the quality assurance methodology and documentation requirements.

14. *Maintains in-depth knowledge of Medicare and Medicaid billing practices, guidelines, laws and regulations to ensure accurate Medicare and Medicaid billing. Reviews and interprets Medicare Local Coverage Determinations and National Coverage Determinations (LCD and NCD) and applies that to the billing process.

15. *Assists Analytics when justification is necessary for unfavorable metrics. Must have the ability to analyze data in Excel or other Epic tools to help with variance analysis.

16. *Utilizes established reporting analytics to monitor department's revenue cycle flow.

17. *Maintains billing and coding education, attends webcasts and conference calls as required.

18. Utilizes process improvement by continuously reviewing, recommending and implementing improvement steps; researching regulatory requirements relevant to charges, monitoring trends, and maintaining knowledge of charge-related regulations and standards; and applying knowledge to ensure that charges are accurate, billed correctly, and supportable according to payer and regulatory requirements.

19. Maintains professional growth and development through seminars, workshops, and professional affiliations to keep abreast of latest trends in field of expertise.

20. Participates in meetings, committees and department projects as assigned.

21. Performs other related projects and duties as assigned.

(Essential Job functions are marked with an asterisk "*").

REQUIRED KNOWLEDGE, SKILLS AND ABILITIES:

1. Extensive knowledge of claims practices including governmental and non-governmental billing.

2. Knowledge of revenue cycle processes and hospital billing to include CDM, UB.

3. Knowledge of code data sets to include CPT and HCPCS.

4. Knowledge of NCCI edits and guidelines, and Medicare LCD/NCDs. Capacity to review, interpret and apply Medicare and NCCI guidelines.

5. Knowledge and understanding of multiple reimbursement theories to include DRG, OPPS, and managed care.

6. Knowledge of hospital compliance.

7. Knowledge of the denial process including appeals, root cause analysis and avoidance or process redesign.

8. Knowledge of the charge master process including new, modifications and deleting of charge master codes.

9. Ability to review, analyze, and interpret managed care contracts, billing guidelines, and state and federal regulations along with facilitating to all member entities.

10. Ability to work and interpret detailed medical record documents and communicate effectively with medical staff, leadership, and other billing personnel.

11. Knowledge of computer hardware equipment and software applications relevant to work functions.

12. Ability to research regulations and claims rules.

13. Ability to analyze reports and identify trends.

14. Ability to communicate effectively both verbally and in writing.

15. Ability to perform crucial conversations with desired outcomes.

16. Ability to establish and maintain effective working relationships with all levels of personnel and medical staff.

17. Ability to problem solve and engage independent critical thinking skills.

18. Ability to maintain confidentiality relevant to sensitive information.

19. Ability to prioritize work demands and work with minimal supervision.

20. Ability to maintain regular and punctual attendance.

EDUCATION AND EXPERIENCE:

Associates in healthcare administration or related area preferred. High school graduate or equivalent required. Minimum of five (5) years' experience in the hospital setting, healthcare industry or coding with a focus in one or more of the following areas: coding, charge, revenue integrity; charge reconciliation; charge compliance; charge auditing; CDM management required. EPIC experience preferred.

PHYSICAL REQUIREMENTS:

(Physical Requirements are based on federal criteria and assigned by Human Resources upon review of the Principal Job Functions.)

(DOT) - Characterized as sedentary work requiring exertion up to 10 pounds of force occasionally and/or a negligible amount of force frequently to lift, carry, push, pull, or otherwise move objects, including the human body.