JOB SUMMARY

The Revenue Integrity Recovery Coordinator is responsible for performing in-depth analysis of patient clinical and billing data to identify documentation opportunities, coding improvements and denial prevention. Develops and implements action plans for denial prevention based on root cause analysis findings.  Promotes revenue cycle operational efficiency, data integrity and compliance with billing and regulatory guidelines. Works closely with clinical areas to effectively document services performed and understand relationship of documentation, medical necessity, coding and charging for all services provided. May be required to travel throughout the system.

ENTRY REQUIREMENTS

Associate Degree is required or Bachelor’s degree required within 2 years of accepting position.  Degree/area of study must be in a healthcare or finance related field.  Bachelor’s Degree is preferred.

Five (5) or more years of experience in coding, billing, charge documentation, charge audit, or charge capture activities is required.

Licensure/certification is required as an RHIA, RHIT, CCS, CPC/COC, or equivalent

Demonstrated knowledge of clinical processes, clinical coding (CPT, ICD-10, revenue codes and modifiers), charging processes, audits and billing.

Experience with coding, and auditing for physician practices required.  RHC experience preferred.

Proficient with MS Excel, Word and PowerPoint.  Experience with Cerner and Star billing systems, report or query writing preferred.

Experience with developing and presenting education to Physicians and clinical departments.

Working knowledge of third party payer rules and requirements.

Knowledge of Ambulatory Payment Classification (APC), Outpatient Prospective Payment System (OPPS) and fee for services reimbursement models, as well as Inpatient, outpatient, and physician practice billing edits.

Exceptional organizational skills and ability to prioritize and manage multiple functions and responsibilities simultaneously.

Excellent communication skills and the ability to work collaboratively with other departments both clinical and non-clinical.

ORGANIZATION

This position reports to the System Manager of Revenue Integrity, and will be responsible for working denials, performing audits, preparing education for improved documentation, and responding to payer audits.

Has working contact with Management, Physicians, and Clinical leaders throughout the system.

AGE OF PATIENTS SERVED

Cares for patients in the age category(s) checked below:

     Neonatal (birth-1 mo)     Young adult (18 yr-25 yrs)

     Infant (1 mo-1 yr)     Adult (26 yrs-54 yrs)

     Early childhood (1 yr-5 yrs)     Sr. Adult (55 yrs-64 yrs)

     Late childhood (6 yrs-12 yrs)     Geriatric (65 yrs & above)

     Adolescence (13 yrs-17 yrs)     All ages (birth & above)

X    No direct clinical contact with patients

SPECIFIC DUTIES

1. Supports the Mission, Vision and Values of Munson Healthcare.

1. Embraces and supports the Performance Improvement philosophy of Munson Healthcare.

1. Promotes personal and patient safety.

1. Uses effective customer service/interpersonal skills at all times.

1. Contributes to the team orientation and long-range goals of Munson Healthcare and is responsible for charging related problem identification and resolution.

1. Collaborates with departments on denial analysis and root cause investigation which includes identifying opportunities for denial prevention.  Performs analysis of data and reporting of trends, performance metrics, process improvements and impact to revenue.

1. Performs other revenue optimization activities as appropriate, which includes providing education, process improvement, ongoing assessment and resolution of root cause issues.

1. Conducts departmental audits to ensure proper documentation and compliance with state and federal guidelines relating to charge capture and billing of services. Prepares and submits audit findings, makes recommendations, and works closely with revenue integrity leadership and other departmental leaders to implement solutions.

1. Collaborates with clinical departments, Patient Financial Services, Patient Access Services, Compliance and other revenue cycle departments on denial coordination, denial prevention, and pre-bill audits.

1. Works closely with Clinical departments and Physician operational leaders, on system implementations, enhancements, and new service line requests to ensure revenue cycle integrity and compliance.

1. Works with ancillary teams and providers to develop processes to prevent future denials.

1. Attends meetings with payer representatives to address outstanding issues and stays informed of new regulations or guidelines. Attends monthly denial management meetings at individual hospitals.

1. Coordinates denials and appeals, and reconsideration requests on clinical, coding, and technical denials with the revenue cycle teams, which may include inpatient and outpatient RAC denials and appeals.

1. Maintains an understanding of regulatory and payer changes to assure correct charging and billing requirements are met.

1. Works collaboratively with the revenue cycle departments to understand payer requirements for coding and billing and clinical documentation to ensure charge accuracy, compliance and optimization.

1. Performs other duties as assigned.