General Summary

Coordinates and directs the corporate Revenue Integrity Team. Serves as a leader in the revenue cycle and is responsible for supporting the revenue capture processes by partnering with the clinical management within the health system. Provides technical expertise, coaches and ensures the accuracy of all charge master data elements such as CPT, HCPCS and revenue codes. Supports the integration of a system wide charge description master and charge capture efforts. Formulates and defines system scope and objectives based on both user needs and a good understanding of applicable business requirements to support the business strategies, strategic vision and goals of the System.

Duties and Responsibilities

Essential Functions:

Provides direct oversight and maintenance of system wide charge description master.Provides leadership and direction to Revenue Integrity staff.Drives process optimization across health system for integration of charges between clinical and financial systems.Directs and participates in complex projects related to revenue cycle initiatives.Validates and educates clinical service areas on appropriate charging protocols in accordance with regulatory requirements.Analyzes data for root cause analysis on complex charge capture design issues. Utilizes software maintenance and report writing tools, as required.Based upon extensive knowledge, validates the use of CPT/HCPCS/UB04 revenue coding, modifiers, CMS billing regulations, and APCs as appropriate.Acts as clinical/coding expert for Revenue Integrity staff.Implements related organizational initiatives in a manner that is inclusive and participatory.Performs charge capture audits as necessary.Monitors department's key performance indicators for both hospital and professional service areas.Supports and manages expansion of revenue cycle enhancements to support health system growth.Reduces denials, improves billing accuracy, and strengthens charge capture workflow performance.Educates providers and leaders on documentation, coding, and charge capture requirements.Implements charge workflows within Epic to prevent missed/late charges.Leads the development, oversight and optimization of Epic Revenue Guardian checks to proactively identify missing or inaccurate charges before claims are submitted.

Common Expectations:

Maintains and/or creates policies and procedures and objectives related to charge capture policies and proceduresContinuously updates information technology skills and knowledge and maintains professional growth and development.Extensive knowledge of charge creation, regulations, charge capture and reconciliation in a health care environment.Selects, trains/orients, assigns department staff, evaluates performance, and makes recommendations for personnel actions.Coordinates and integrates services of teams, with other departments/service lines/entities, and with the System's primary functions. Participates in the selection of outside services (if needed).Is responsible and accountable for the department's budget.Continuously assesses and improves teams. Maintains appropriate quality control/assessment programs (if applicable).Maintains appropriate records, reports, and files as required.Provides outstanding service to all customers; fosters teamwork; and practices fiscal responsibility through improvement and innovation.

Qualifications

Minimum Education:

Bachelors Degree Required

Work Experience:

5 years Charge master maintenance management experience with some personnel management experience. Required andMust have a good understanding of the functionality of patient charges and the relationship between the CDM and the revenue cycle. Required

Licenses:

Certified Coding Specialist Upon Hire Required orCertified Professional Coder Upon Hire Required

Knowledge, Skills, and Abilities:

Must have a good understanding of the functionality of patient charges and the relationship between the CDM and the revenue cycle.Able to work well in a team environment as a member and/or leader.Able to accept responsibility.Thorough knowledge of relevant specialty areas.Analytical and logical approach to solving problems.Clarity and discipline in communication skills- written and verbal.Capable of imaginative and abstract reasoning.Advanced trouble shooting skills.Self reliant and capable of independent work.Proficient in Epic Hospital Billing (HB) and Professional Billing (PB), with advanced knowledge of charge capture workflows, claim generation, reconciliation, and billing edits to support accurate and compliant revenue capture.

Benefits Offered:

Comprehensive health benefitsRetirement savings planPaid time off (PTO)Education assistanceFinancial education and support, including DailyPayExpanded Paid Parental Leave

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