Avita Health System currently operates three major healthcare facilities and 31 clinic locations throughout North Central Ohio. Within the last three years, the system has tripled in size branching out into ten communities throughout the region. There are over 1,800 employees and 110 employed member multispecialty group of physicians and advanced practitioners that provide these communities with optimal, high-quality healthcare. In 2015, Avita has received a national award, placing them in the top 10 percent nationally in customer service.
Avita Health System continues to grow, and with our expansion we have various open positions in our Bucyrus, Galion and Ontario locations.
We are currently accepting resumes & applications for the following position, located at our Crestline, Ohio location:
Supports the enhancement and maintenance of properly functioning revenue cycle processes to ensure the integrity of revenue charge capture and full collection of expected net revenue for both hospital and provider services. Oversees maintenance of hospital and provider chargemasters. Ensures organization is in compliance with all price transparency regulations.
DUTIES AND RESPONSIBILITIES
Underpayment & Analysis Recovery
1. Monitors to ensure payers are upholding regulatory and contract terms by conducting payment discrepancy analyses, initiating underpayment reclamation, monitoring payment activity, and communicating with payers to recoup underpaid amount.
2. Develops and implements processes and reporting to monitor managed care reimbursement accuracy, including identifying appropriate tools to monitor the reimbursement practices of third-party payers and ensuring contract language results in accurate reimbursements.
3. Evaluates incoming payments and stated contractual adjustments to identify underpayments and potentially incorrectly posted contractual adjustments.
4. Maintains a detailed tracking system of all billed accounts to reference during recovery efforts.
5. Analyzes data to determine if underpayments resulted from inaccurate coding, charge capture calculations, or billing submissions; develops, implements, and monitors action plans to resolve core issues as well as recoup underpayments.
6. Conducts various calculations and analyses to determine large dollar underpayments and payer trends, resolves individual claim underpayments, and addresses trends with payers.
7. Remains current with payer contracts and billing regulations to identify accurate payment methodology and misuse.
8. Plans, directs, coordinates, and implements a fully integrated program to audit for accurate and complete charge capture by clinical departments and automated EMR and supply capture systems.
9. Oversees the education of revenue department managers and directors regarding the relevance of their roles and responsibilities to effective revenue capture.
10. Consults with department managers to help develop and implement policies and procedures for the purposes of reconciling charges posted in the billing system with other source information.
11. Collaborates with Medical Records Clinical Documentation Improvement (CDI) specialist to complete chart to charge audits to verify correct and comprehensive charging practices and promote accuracy and integrity of hospital charges.
12. Assists with the management of clinical documentation review processes to promote the integrity of the revenue charge capture system.
13. Analyzes non-covered charge and procedure denials to determine appropriate charging practices; implements action steps to address; and monitors to ensure compliant billing, appropriate payment and adjustment, and accurate WRVU capture.
14. Identifies opportunities for charge capture improvement by implementing and analyzing the results of routine and/or random audits.
15. Provides an audit statistic report to identify departments showing a trend of over charges and under charges including departmental error rates. Assists clinical department leadership in creating corrective action plans for resolution and to prevent errors from reoccurring. Monitors to ensure action plan success.
16. In collaboration with clinical and finance teams, ensures hospital and physician chargemasters have correct CPT code assignments and charge amounts that are market-competitive while being above highest fee schedule amount and compliant with government and payer contracts.
17. Oversees CDM maintenance and enhancement by analyzing departmental charges, identifying and implementing charge improvements, assisting individual departments with reconciling charge discrepancies, and determining the reimbursement impact of CPT revisions.
18. Maintains and monitors the process for calculating price recommendations for Controller or CFO approval.
19. Performs audits and monitors chargemaster and payer fee schedules and reimbursement methodologies to ensure pricing/charges exceed minimum payment reimbursement levels and fee schedules.
20. Reviews changes in pricing, CPT codes, HCPCS codes, and revenue codes for accuracy and compliance with all applicable billing guidelines and optimization of reimbursement.
21. Supports the organization's Corporate Compliance Program by verifying adherence to charge posting policies and procedures and ensuring that the chargemaster complies with all applicable regulatory guidelines.
22. Chairs organization's Chargemaster Committee.
23. Continually monitors government regulations and payer documentation to ensure the organization is in compliance with all price transparency requirements.
Additional Audits and Analysis
24. Conducts service line and new product analyses and provides information to organizational leadership.
25. Serves as the primary contact for chart/charge/contract term audits.
26. Develops and maintains payer scorecards to leverage during contract negotiations and provider/payer meetings.
27. Provides leadership, coaching, and day-to-day oversight and guidance to Revenue Integrity team.
28. Secures the training and information resources required to support the Revenue Integrity team.
29. Develops and maintains policies and procedures that will improve and support overall revenue cycle functioning and organizational goals.
30. Develops, monitors, and maintains productivity and quality standards and monitors staff performance, workloads, and workflows against the standards. Initiates workflow improvements and standardization to increase efficiency and accuracy.
31. Coordinates hiring, orientation, and training programs for department staff. Sets performance standards.
32. Conducts disciplinary discussions and completes required documentation in a respectful, timely manner.
33. Completes staff performance evaluations and forward to Director at least 30 days prior to the staff member's anniversary date.
34. Maintains departmental expenses within budget or provides reason for approved variance.
35. Establishes effective communication protocols and promotes collaborative efforts within the department and among all related revenue cycle functions, and internal and external stakeholders, which include employees; patients and family members; physicians; and third party payers.
36. Designs efficient operational workflows, including identifying software, space, and equipment needs to support the Revenue Integrity functional objectives.
37. Identifies and documents staff training needs; implements needed internal training; and presents recommendations for external training to Director.
38. Responds promptly to written and verbal inquiries and requests from internal customers, third-party payers, and vendors.
39. Keeps Director informed of accomplishments and obstacles. Recommends action steps to address opportunities to improve and suggests acknowledgements and rewards for positive improvements.
40. Focuses at all times on modeling appropriate behavior and exquisite customer service skills.
41. Maintains a professional, working relationship with other hospital department employees and insurance company and vendor representatives.
42. Maintains and supports compliance standards
a) Ensures confidentiality of all patient, department, hospital, and other information and records. Secures documents and other information in order to protect patient confidentiality.
b) Refers issues of concern to Director or Compliance Officer.
43. Maintains current knowledge of all organizational compliance policies and procedures and performs duties accordingly.
44. Stays informed of changes in the healthcare industry via newsletters, websites, educational seminars, and active participation in revenue cycle professional organizations.
45. Performs other duties as assigned.
• Bachelor's degree in business, health or public administration, or a related field.
• At least 7 years of work experience related to healthcare business operations, reimbursement, and/or revenue integrity.
• In-depth understanding of payer contracting and reimbursement models.
• Knowledge and understanding of managed care payer rules.
• Understanding of coding classification systems, such as ICD-10-CM, ICD-9-CM, MS-DRG, APR-DRG, EAPG, and HCC.
• Previous management or supervisory experience.
• Knowledge of critical access and RHC reimbursement methodologies and cost report impact on final reimbursement.
• Previous experience building and maintaining a contract management system.
• Previous hospital billing experience and demonstrated knowledge of third-party and self-pay billing procedures and claim review and analysis.
1st Shift: 8:00 AM to 5:00 PM
Monday through Friday
Full-Time: 80 Hours Bi-Weekly
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