ABOUT NCH
NCH is an independent, locally governed non-profit delivering premier comprehensive care. Our healthcare system is comprised of two hospitals, an alliance of 700+ physicians, and medical facilities in dozens of locations throughout Southwest Florida that offer nationally recognized, quality health care.
NCH is transforming into an Advanced Community Healthcare System(TM) and we’re proud to: Provide higher acuity care and Centers of Excellence; Offer Graduate Medical Education and fellowships; Have endowed chairs; Conduct research and participate in national clinical trials; and partner with other health market leaders, like Hospital for Special Surgery, Encompass, and ProScan.
Join our mission to help everyone live a longer, happier, healthier life. We are committed to care and believe there's always more at NCH - for you and every person we serve together. Visit nchjobs.org to learn more.
JOB SUMMARY
The Revenue Integrity Specialist creates, maintains, and oversees reporting, analysis, and reconciliation related to gross and net revenue, specifically but not limited to denials management, charge lag, and charge capture. The Revenue Cycle Integrity Specialist will be responsible for the reeducation and training of front-end staff as a result of registration denials, authorization denials, and charge entry denials. Partners with NCH Physician Group Credentialing with the maintenance of the Fee Schedule (CDM) for all of NCH Medical Group. This position will partner with the Compliance Department and all revenue producing departments regarding workflow around new services, charge capture and reconciliation.
ESSENTIAL DUTIES AND RESPONSIBILITIES
Other duties may be assigned.
· Liaison between Central Billing Office and Operations.
· Lead implementation for any current and future third-party systems.
· Stays current with regulatory revisions in payment methodologies via seminars, websites, etc.
· Works closely with department managers in adding/changing/deleting any charge or clinical orders in the EMR.
· Works closely with the Assistant Director of Revenue Cycle to identify CPT, ICD-10, and HCPCS updates and changes.
· Liaison between Practice Managers and Central Billing Office in identifying proper coding (HCPCS, CPT, ICD-10, etc.). Provides Training and reeducation as needed.
· Analyzes workflow and operational procedures to identify opportunities for improved reimbursement.
· Assists Revenue Cycle leadership in development of policies and procedures to ensure all services are captured, recorded, processed, and billed in an accurate and timely manner.
· Performs research on best practices and national benchmarks in the healthcare industry revenue cycle to assist in standardization of goal setting and performance monitoring.
· Analyzes billing to ensure charge reconciliation and works closely with the practices to educate and identify areas for revenue opportunities.
· Researches and distributes relevant charge services related regulatory updates to applicable department heads.
· Reviews and resolves edits, suspense charges and interface error charges where necessary.
· Works closely with Patient Accounting to ensure all billing edits and coding issues are corrected in the Revenue Cycle, where applicable.
· Works closely with Compliance Department for internal and external audits/reporting.
· Actively participates in all Revenue Cycle related special projects and daily, monthly, and yearly reporting.
· Works with Managed Care area to ensure appropriate contract information is in place regarding procedure codes and specialty areas.
· Works with Coding Department, Registration areas and Information Technology Services to ensure appropriate flow of charts for coding, as well as the set-up for new services regarding charging, coding, and billing
· Demonstrates regular, reliable, and predictable attendance.
· Works alongside auditing to attend onboarding provider meetings.
· Assists the Credentialing Contract Analyst with identifying payment variances.
· Conducts end of day batch auditing for charges and payments.
· Audits governmental forms/questionnaires including (but not limited to) ABNs, Insurance Waivers, and MSPQ.
EDUCATION, EXPERIENCE AND QUALIFICATIONS
· Minimum of Associates Degree with 3 years relevant experience in hospital, clinical, or insurance company with revenue cycle experience required OR High School/GED with 6 years in hospital, clinical, or insurance company with revenue cycle experience required.
· CPC credential from American Academy of Professional Coders (AAPC) required within 12 months of hire date.
· Training experience preferred.
· Excellent written/oral communication skills required.
· Ability to problem solve and work independently.
· Detail oriented.
· Proficient in Microsoft Office – specifically Excel and/or Access.
· Knowledge of healthcare reimbursement and third-party payer guidelines.
· Strong analytic aptitude.
· Excellent project management skills.
· Reliable high-speed internet required
· Reliable phone service required
· Intermediate computer knowledge: Uses Microsoft Word, Excel, Outlook, and Windows
