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Description PeaceHealth is seeking a Revenue Integrity Coordinator for a Full Time, Day position.JOB SUMMARY The position is a key supportive position assigned to internal customers and as such is responsible for understanding their business and operational needs, supporting and furthering their goals and priories within the context of the goals and priorities of the system services and the mission and values of PeaceHealth. This position will help assign charge structure in keeping with system standards. It is responsible for providing credible and understandable information about revenue leakage to the network. This position will provide denial management information to clinical or operational managers who will work to reduce denials. ESSENTIAL FUNCTIONS
Develop and maintain business partner relationships including a detailed understanding of the business units and programs in the network being served. Ensure the appropriate charges are set up and available for every service performed in the network. As the networks change the location, structure or documentation of clinical services, this position will provide oversight to ensure revenue maximization, overall billing compliance and adherence with system standards.
Develop, monitor and report defined denial metrics that support network and system wide initiatives. Assist in the facilitation of the reduction of denial trends and other revenue leakage Responsible for leading assigned projects or committees and serving on assigned committees/boards on behalf of System Revenue Integrity.
Facilitate Medicare regulatory changes affecting PeaceHealth to ensure compliance with Federal and State laws and timely billing. As Medicare changes the rules on what is billable, what you can or can’t bill for, or how something needs to be documented, this position will link back to the appropriate departments to ensure we are in compliance with the most recent regulations. This work might involve physician education, clinical education, or network/system services education.
Provide information to Networks on missing or delayed revenue and obtain resolution to capture that revenue. Including escalation to the appropriate parties if issues are not resolved.
Responsible for developing and implementing plans to meet or exceed customer needs and simultaneously assume excelling quality and service outcomes.
Act as a key member in the team that manages the charge master structure and critical coding that it contains. This position will act as a consultant to the CDM manager and will be a member of the group that determines the correct naming conventions, cpt and revenue codings, and charge capture methods for the charge masters that are used system wide.
Work effectively with other System services departments to streamline revenue capture. This might include HIM, UR/Care Management, Finance, Reimbursement, Accounting or other PFS departments.
Perform other duties as assigned
QUALIFICATIONS
EDUCATION:
Bachelor’s degree in Accounting, Finance, Business Administration or related field required; or combination of education and experience that provides the caregiver with the requisite knowledge, skills and abilities to perform the job required.
EXPERIENCE/TRAINING:
Minimum of five years of experience in a hospital finance or business office setting with increasing responsibility required.
LICENSE/CERTIFICATION: OTHER SKILLS:
Demonstrated excellent communication and organizational skills including writing and speaking both with individuals and groups at all levels within the PeaceHealth organization.
Strong verbal, written and interpersonal communication skills
Excellent attention to detail with strong analytical and problem solving skills;
Advanced computer skills to include Excel, Word, and knowledge of software for hospital contract and/or claims management
Ability to accurately run reports and analyze data; ability to navigate multiple software sites simultaneously
Ability to work autonomously or as part of a team.
Demonstrated ability to work efficiently and responsibly in a collaborative environment with multiple work demands and short time frames.
Strong attention to detail.
Must be well organized and self-motivated.
Strong communication skills, both verbal and written.
Strong analytical, critical thinking and problem solving skills.
Ability to make objective assessments.
See how PeaceHealth is committed to Inclusivity, Respect for Diversity and Cultural Humility. For full consideration of your skills and abilities, please attach a current resume with your application. EEO Affirmative Action Employer/Vets/Disabled in accordance with applicable local, state, or federal laws.REQNUMBER: PH-INFOR-3331
