Company :

Allegheny Health Network

Job Description :

GENERAL OVERVIEW:

The position provides practice and regulatory guidance and enhancement to facilities and 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. Collaborates and helps to optimize clinical documentation through analysis and prioritized evaluation. Works collaboratively with clinical staff, 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.

ESSENTIAL RESPONSIBILITIES:

• Acts as primary revenue cycle liaison for the most complex clinical departments and practices and acting with a high degree of autonomy. Monitors charge reconciliation reports to identify trends including compliance issues, missing charges and areas of vulnerability. Provides guidance, communication and education on correct capture, coding and billing processes to multiple clinical departments and practices. Provides expertise in the evaluation of new technology, services and programs. (40%)

• Performs complete revenue cycle reviews, including Charge Description Master (CDM) and related audits with a focus on revenue cycle integrity.Evaluates current charging and coding structures and processes in clinical departments to ensure appropriate capture and reporting of revenue and compliance with government and third party payor requirements.Assesses the accuracy of all charging vehicles, including clinical systems and dictionaries, encounter forms and other charge documents. (20%)

• Leads and participates in complex projects related to revenue cycle initiatives. Provides oversight for projects in which RI analysts are involved. Develops, implements and maintains Revenue Integrity and CDM Management policies, procedures and training materials. (20%)

• Collaborates with Compliance, Budget Office, Patient Accounts, Health Information Services, Internal Audit and other Revenue and Finance departments on revenue management initiatives. (10%)

• Develops and maintains a Quality Audit program and associated reporting. Assists in performance of quality audits related to other team members' identified areas of opportunity. (10%)

• Other duties as assigned.

QUALIFICATIONS:

Minimum

• Bachelor's Degree in Business, Healthcare or related field OR six (6) of related experience in lieu of degree

• 5 years hospital or physician revenue cycle, billing, coding or billing

• Experience with electronic health records (EPIC)

Preferred

• 3 years in a Epic-billing environment

• 3 years with specific emphasis on regulatory issue and policy development, advanced knowledge of healthcare regulatory policies

Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement : This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.

As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy.

Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.

Pay Range Minimum:

$28.18

Pay Range Maximum:

$43.80

Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, age, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, age, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.

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Req ID: J240106