Works directly with healthcare customers to improve revenue management processes, reduce denials, improve cash flow and net revenue, and reduce compliance risk. Serving as industry expert while implementing best practices at customer locations.
- Provide mastery level consulting to hospitals seeking Revenue Cycle insight and guidance to ensure best practices.
- Serve as a Project Manager to oversee the daily operations of the Revenue Cycle to ensure best practices.
- Complete revenue cycle assessments by reviewing current operations and conducting key interviews to identify opportunities for improvement.
- Perform comprehensive assessments of charge capture and reconciliation procedures to ensure all services provided are charged.
- Assess charge ticket and interface mappings to the CDM to identify discrepancies.
- Test claim logic within billing and scrubber systems to ensure accurate flow of coded data to the bill and to the payor.
- Conduct CDM reviews to assure all lines are coded correctly and all services rendered are available to charge.
- Conduct audits to assess the accuracy and completeness of the bills, coding, medical record documentation, and/or level of care assignment to ensure regulatory compliance and maximize revenue opportunities.
- Review medical records and utilize clinical knowledge and regulatory guidance as well as knowledge of payer requirements to determine reasons for denial and whether an appeal is warranted.
- Write persuasive Appeal letters to maximize chance to overturn denials.
- Conduct Root Cause Analysis and create Corrective Action Plans to eliminate reasons for denial.
Knowledge, Skills, Qualifications, Experience
- In-depth knowledge and understanding of healthcare services, health information technology, regulatory requirements, clinical data management, project management.
- Exceptional communication skills both written and verbal.
- Proficiency with Microsoft Office and associated Craneware tools (BA, CMT, PCL, SCL, ISD, ISA, ISMN).
- Research and analysis skills.
- Demonstrates a high level of commitment to superior customer satisfaction through the entire duration of the customer relationship.
- Highly accountable and results oriented, burning desire to get things done and a sense of urgency, resourceful with excellent planning skills.
- Ability to assess risk within projects and formulate plan to mitigate or avoid said risk.
- Dedication to staying current with industry changes and advances.
- Educated to Bachelor Degree level
- RN, BSN, CPC, COC or CCS certification
- 7+ years’ experience in revenue cycle management and healthcare operations
- 5 years’ experience managing project teams
- 5+ years’ experience working with commonly used financial systems and transaction processing systems such as EPIC, McKesson, Cerner, Meditech, Paragon, CPSI, GE, and Siemens