Provides practice and regulatory guidance and enhancement to the physician practice or department & physician organization's Revenue Cycle Center (RCC) with end to end procedure optimization. Develops and implements Revenue Cycle regulatory program through a structure that promotes compliant operations throughout the Revenue Cycle continuum. Activities include analysis (including root cause), monitoring & auditing, reporting & education with regards to Revenue Cycle training & problem resolution with all level of leadership including physicians, service line VP's, CAO's, CFO's etc. Establishes and implements appropriate internal controls to achieve complete and accurate documentation & billing processes. Designs and refines denial management programs with emphasis on medical necessity denials; collaborates and helps to optimize clinical documentation through analysis and prioritized evaluation. Works collaboratively with practices and leaders to enhance work flows and procedures by identifying training and development needs for all processes within the Revenue Cycle, as well as appropriate hand-off for designated topics. Collaborates with physician practice and clinical departments and other stakeholders. Incumbent will be responsible for Revenue Cycle analysis and evaluation for all practices and the RCC.
- Responsible for financial, statistical and operational projects assigned by the Director Regulatory Affairs & Administrative Support; present detailed analysis of A/R performance and other financial reports and related outcomes/trends; researches and validates clinical data used to support medical necessity of billed services, conducts quality assurance reviews of various billing components, technical requirements, supporting processes, systems and required documentation; reviews outcomes with wide array of people (i.e., Practice Directors, Practice Managers, Physicians [as requested], senior leadership, PO Coding Manager, hospital case management, managed care contracting and RCC management) and influences adjustments to current practices.
- Responsible for monitoring and auditing of Revenue Cycle issues; monitor Practice and RCC staff performance relative to current Revenue Cycle policies and procedures, including medical necessity issues of billed services through sample audits; research regulatory concepts for gaps and opportunities to improve Revenue Cycle compliance; identify under- and over-charge items for immediate resolution by the provider/practice; identify areas for risk as well as improvement - conducts assessments both desk level and on site.
- Provides ongoing education to providers, practices and RCC staff concerning practice management system, coding and regulatory complexities (i.e., billing and A/R management workflows, policies and requirements); develops and implements action and educational plans to target resolution of Revenue Cycle issues; identify training needs as well as appropriate hand-off for designated topics; assist with training and implementation of PM system for newly acquired Practices relative to front-end Revenue Cycle edits or other systematic issues and supportive medical record documentation.
- Performs ad hoc consultative research and coordination on current issues of Revenue Cycle regulatory risk including medical necessity denials; identifies a framework of continuous improvement to accomplish programmatic goals; facilitates meetings both internal and external; works collaboratively with system compliance leadership to coordinate and manage RAC and payer audit appeals. Serves as the Revenue Cycle regulatory liaison between the Practice and the RCC for efficient management of accounts receivable, point of service Revenue Cycle activity and all other areas within the Revenue Cycle area; serves as an internal audit consultant to clinical providers. Identifies barriers and implements corrective action measures in partnership with leaders to ensure positive outcomes. Provides ongoing guidance, training and support to practices and departmental Revenue Cycle staff. Works collaboratively with physicians, leadership, and health professionals to accomplish organization and Revenue Cycle and practice goals.
- Performs other duties as assigned or required.
- BS/BA degree in healthcare or Business Administration or equivalent education and experience
- 5 years related experience
- Experience in EPIC – billing environment
- Experience with specific emphasis on regulatory issues and policy development, management experience, and advanced knowledge of healthcare regulatory policies, practices and systems relative to the revenue cycle
- Management experience
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