Location: San Francisco, CA
Job Function Summary:
- Involves revenue cycle functions for the healthcare enterprise, including system billing, reporting and support.
- Ensures account information contains accurate and comprehensive data to provide timely billing and optimal reimbursement for services.
- Impacts processes to include charge capture, coding, insurance identification, data entry, billing, payment posting, refund processing and collections.
- May also be responsible for / integrated with business office operations.
- Experienced professional who knows how to apply theory and put it into practice with in-depth understanding of the professional field; independently performs the full range of responsibilities within the function; possesses broad job knowledge; analyzes problems / issues of diverse scope and determines solutions.
- The Service Line Specialist serves as the key liaison and subject matter expert for assigned service line areas regarding all aspects of charge capture/charge description master processes.
- This position also has a broad understanding of all areas of the revenue cycle; including Patient Financial Services (PFS), Health Information Management (HIM), and Reimbursement Services.
- This position will lead, support, and coordinate on-going charge capture improvement initiatives for assigned service line areas; including charge reconciliation activities, new service implementation, and identification of revenue management opportunities.
- The Service Line Specialist will coordinate all Revenue Integrity activities on behalf of assigned service line areas; department charge capture education, charge audit activities, charge description master management, and monitoring of charge capture related metrics.
- Revenue Management Department has responsibility for patient chargeable services, supplies and pharmacy items including charge description master (CDM) and fee schedule set up and maintenance, CPT/HCPCS and revenue code assignment, pricing, charge capture and revenue reconciliation activities, and acts as a liaison between Finance and operational leaders.
- Liaisons with departments to thoroughly define reporting and information requirements.
- Identifies data source, develops and delivers routing and adhoc reports and presentations.
- Acts as the charge capture subject matter expert and initial contact to assigned clinical areas.
- Evaluate revenue cycle inquiries and propose improvements or enhancements to system to maximize revenue.
- Conducts and evaluates annual charge capture reviews and workflows to ensure consistent principles with coding, nomenclature and pricing for assigned cost center and/or new department creation.
- Collaborates with departments to design new workflows and conducts charge validation in order to maximize revenue.
- Regularly reviews and updates charge capture related policies and procedures for assigned clinical areas.
- Provides timely educational intervention in support of charge capture processes.
- Develops training materials for clinical area use and reference.
- Conducts and leads regularly scheduled, on-site meetings with assigned service line clinical departments to ensure accurate and charge capture practices and workflows are in place; including daily charge reconciliation.
- Revenue / WQ Monitoring and Oversight
- Monitors gross revenue metrics against established benchmarks for assigned cost centers; assist clinical department to identify revenue variance root-causes and mitigation of discovered issues and communicates to Service Line Special Lead and Revenue Integrity Manager.
- Applies dashboard and other processes for continuous analysis of complex revenue cycle functions of diverse scope.
- Audit data input for validity and accuracy.
- Work proactively with departments across the system to assure appropriate revenue cycle practices and compliance with internal and external regulations.
- Performs daily review and monitors clinical department workqueues (APeX Charge Review, Account, and Charge Router Review workqueues, etc) and provide assistance to department representatives to resolve issues, as needed.
- Actively resolved edits routing to Revenue Management owned work queues, performed ongoing trending and root-cause analysis.
- Independently generate reports and analyze complex financial data.
- Identifies trends in revenue cycle operations and presents reports to all levels of hospital management and physician leaders.
- This includes, but not limited to, MyReports, Cognos, RevDash, Performance Portal, etc.
- Collaborates with the Revenue Integrity CDM Manager to support ongoing CDM updates, preference list maintenance, or charge interface charging mechanisms.
- Coordinates system related upgrades or application updates between assigned clinical areas and Information Technology department.
- Collaborates with Advisory & Audit Services, Compliance, other internal/external auditor(s) to review results from retrospective and concurrent audits, develop an action plan to resolve discovered issues, and ensure implementation.
- Engages Patient Financial Services (PFS), Health Information Management (HIM), and other departments to determine denials and work queue edits and mitigation plans.
- Monitors and completes assigned APeX ServiceNow tickets.
- Ensures tickets are completed to the satisfaction of the end user.
- Reviews Medicare intermediary and third-party payer bulletins, memos and websites to keep current on coding requirements, pending changes, and communicate relevant information to all applicable departments.
- Performs other duties as assigned and appropriate to the position.
Knowledge, Skills and Abilities:
- Four (4) to six (6) years of experience in clinical charge capture, charge description master, coding, government/third-party reimbursement, or similar healthcare experience
- Thorough knowledge of the practices, procedures, and concepts of the healthcare revenue cycle, specifically revenue integrity, and its component operations, including billing, coding, collections, charge capture, contractual adjustments, third-party reimbursements and compliance.
- Experience in managing and/or developing charge description master or charge capture processes, policies, and/or procedures.
- Knowledgeable in use and application of Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS), and Revenue codes.
- Thorough understanding of the issues, processes, reporting instruments, metrics, analytics, and other tools and techniques involved with measuring and analyzing the revenue cycle.
- Detail-oriented, with proven ability to effectively manage time, see tasks and projects through to completion, organize competing priorities and effectively address complex, urgent issues as they arise.
- Strong skills in report development, dashboard design, and various software tools specific to healthcare revenue cycle management.
- Skills in common database, spreadsheet and presentation software.
- Strong communications skills, with the ability to interpret and convey complex clinical finance information in a clear, concise manner.
- Ability to prepare compelling and informative reports and presentations.
- Strong analytical and problem-solving skills, with the ability to evaluate the effectiveness of workflows and systems and propose innovative solutions.
- Strong interpersonal skills, with the ability to collaborate effectively on complex projects in a team environment with staff from a wide variety of business and clinical areas.
- Proven ability to work with managers, serving as a technical resource, providing recommendations and advice on complex regulatory changes, and industry trends and developments in revenue cycle management.
- Practical experience using hospital information systems, Epic billing system preferred, and computer proficiency with PC applications (e.g. Microsoft Office).
Education, Licenses and Certifications:
- Bachelor’s degree in related area and/or equivalent experience/training (required)
- Master’s degree in related area and/or equivalent experience/training (preferred)