Employment Opportunities

General Description

Responsibilities

• Act as a resource for documentation, coding, claim review process, and billing questions for all Health Systems by staying up-to-date with local, state, federal laws, regulations and guidelines, as well as monitoring payer bulletins, periodicals and web-sites to maintain revenue cycle knowledge.
• Perform coding quality audits (monthly or weekly) of medical records to assure appropriateness and accurate code assignments in accordance with Center of Medicare and Medicaid (CMS) guidelines, CPT guidelines and health systems policies and procedures.
• Completes capture of patient revenue in every area that generates charges, management in relation to charging mechanisms and triggers, ensuring clean handoffs between clinical departments, strategic pricing, denials management, billing management and clinical operations relations.
• Fosters partnering relationships with the Compliance, Business Office, Health Information Management department, and other third parties to ensure the accuracy of the Charge Description Master (CDM) and fee schedules.
• Oversees CDM maintenance and enhancement by analyzing departmental charges, identifying and implementing charge improvements, assisting individual departments with reconciling charge discrepancies, and determine the reimbursement impact of CPT revisions.
• Coordinates with Finance/ Business Office, Health Information Management and other coding professionals to ensure that the codes contained in the charge description master and professional fee schedule are accurate and in compliance with regulatory and/or contractual guidelines and that claims logic is appropriate for accurate billing.
• Review of monthly reports to provide educational feedback on areas of possible documentation improvement to staff and providers.
• Provides on-going education, communication and   meets with each medical coder and biller to review the results of each audit and provides feedback to resolve issues found in the audit with re-training or other educational methods
• Assists Compliance Officer in planning and execution of compliance reviews, audits and activities.
• Assesses changes in the regulatory environment; researches, investigates and responds to issues related to documentation, coding and billing.
• Assists, coordinates and participates in the record/claims audit process, provides documentation and compliance education sessions to physicians and other staff.
• Assist the Compliance Officer with other aspects/projects/tasks/reviews of the compliance program to assure compliance with applicable state and federal and CMS regulations.
• Implement changes in workflows and ques with the goal of improving Absentee Shawnee Tribal Health System’s compliance in all aspects of operations, effectiveness and efficiency in billing and coding processes.
• Revise, change, edit and monitor workflow with the goal of determining best practices to result in compliance and maximization of revenue.
• Performs Gap Analysis of all the Revenue Cycle departments and makes recommendations for process improvements and training.
• Designs, analyzes, and implements information and reporting systems to monitor, detect and correct variations in revenue cycle performance
• Review reports to determine best practices and track performances of those practices and promote potential changes, as needed.
• Resolves escalated issues that arise from operations and require coordination with other departments
• Participate in Business Development initiatives to ensure proper compliance
• Follow changes and policies within the industry, preparing plans and goals to grow with the changes; follow company policy changes and projections that may impact Absentee Shawnee Tribal Health System’s services and programs.
• Administer and uphold all of the Health System’s policies and procedures; recommend changes and/or creation of policies and procedures to enhance compliance and revenue management
• Communicate with Company’s employees and potential Business Associates as needed
• Assists strategic sessions with management and health board of director to promote cost effectiveness of practices and procedures

• Communicate regularly with the compliance officer, management and health board of director management as needed
• Attend meetings and in-services as requested
• Assist in producing, editing, revising various documents such as but not limited to; policies and procedures, job responsibilities, job expectations, performance appraisal forms, surveys, etc.
• Train additional team members, as needed
• Attend continuing education activities to maximize knowledge
• Maintain needed education and certifications
• Coordinate with Health System’s Compliance Committee
• Participate in quality improvement programs as necessary
• Continuously works towards the Health System’s goal and vision
• Additional duties as assigned by Supervisor

Education, Qualifications & Requirements

• Bachelor’s degree related to health care or information systems, business or related field required
• Experience in E-clinical works Healthcare system for 3 years
• Must have a working knowledge of reimbursement regulations for Medicare, Medicaid and Managed Care.
• Ten (10)  years of experience in management of clinical billing or healthcare experience required with  extensive knowledge of  ICD-10-CM and CPT coding principles and guidelines
• Extensive knowledge of federal regulations and policies pertaining to documentation, coding, and billing
• Must know how to perform proper revenue and reimbursement capture.
• Must be highly analytical, detailed and independent.
• Proven communication, organizational, and leadership skills required. 
• Other education and experience substituted for above requirements require approval by Executive Director.

• Extensive knowledge of  revenue cycle and compliance procedures
• Considerable knowledge of industry laws, regulations and policies
• Ability to establish and maintain positive relationships with employees, management, clients, vendors and external contacts
• Competent in Health Informatics Body of Knowledge and Practice
• Knowledge of local, state and federal regulatory requirement related to the functional area.
• Ability to conduct and interpret qualitative and quantitative analysis, financial analysis, healthcare economics and business processes, information systems, organizational development, health care delivery systems, project management or new business development.
• Ability to manage, organize, prioritize, multi-task and adapt to changing priorities.
• Ability to provide leadership and influence others.
• Ability to foster effective working relationships and build consensus.
• Ability to mediate and resolve complex problems and issues.
• Ability to develop long-range business plans and strategy.

• Sedentary work; Computer usage, sitting, walking, bending/stooping, climbing stairs, kneeling/squatting, reaching, twisting.