DME Revenue Integrity Coordinator

Unity Health•Bentonville, AR

About The Position

This Coordinator has the responsibility of interpreting government regulations and affecting process changes throughout UMES to ensure compliance with these regulations. This position is responsible for the accuracy of the Charge Description Master (COM) as designated by regulatory agencies and payers. Duties include analysis and verification of charging procedures, ensuring correctness of coding in the COM and providing education to UMES management in the accuracy of charges. This position is responsible for the analysis and assessment of diverse data relating to the revenue cycle. This requires extensive knowledge of all aspects of the revenue cycle, including the registration, coding, billing and collection processes, as well as government and payer regulations. Acting as an internal consultant, this Coordinator provides essential quality evaluation, reports, advice and improvement recommendations to management in all service lines. The Revenue Integrity Coordinator is required to understand and communicate complex issues and changes relating to regulatory compliance and third-party reimbursement to the department(s) involved, maintaining records of their notification, accountability and compliance. This position is responsible for assessment of individual and departmental compliance issues and reporting any non-compliance through UMES Service Line structures. This position works closely with Patient Financial Services staff and UMES Service Line management staff to provide accurate, critical information for identification of areas needing immediate attention to expedite compliance, recommend revenue cycle process improvements and collect every dollar owed. This position is responsible for the development and execution of training and quality assurance programs for all Patient Financial Services and other revenue cycle functions as assigned. A Revenue Integrity Coordinator is highly skilled and works at a fully cross-functional level. This employee has a working knowledge of all functional areas for UMES Revenue Cycle performance including but not limited to the following: Outpatient Registration Charge Capture and Protection Regulatory Compliance Reimbursement and Cost Reporting Pre-Encounter Processing Billing and Claim Submission Health Information Management State Recovery Audits Financial Screening and Counseling Third-Party and Guarantor Follow-up Federal Recovery Audits Commercial Payer Audits Front-End Collections Cashiering, Refunds and Adjustments Health Information Management Medical Necessity Customer Service Denial Management and Avoidance

Requirements

Must be able to accurately type 25-30 words per minute
Must exhibit competency with Microsoft Office applications
Five (5) years minimum recent experience in the healthcare industry required
Working knowledge of healthcare revenue cycle functions including coding and billing guidelines, government payer regulations and cost reporting
Must have revenue code and CPT coding knowledge
Working knowledge of multiple reimbursement systems including Prospective Payment System (PPS)
Proficient skills to collect, organize and analyze data, produce reports and recommend improvements and solutions
Strong communication, teaching and presentation skills
Ability to interpret and implement regulatory standards

Nice To Haves

Bachelor’s degree in business or health administration preferred
Medical terminology preferred

Responsibilities

Interpreting government regulations and affecting process changes throughout UMES to ensure compliance with these regulations
Responsible for the accuracy of the Charge Description Master (COM) as designated by regulatory agencies and payers
Analysis and verification of charging procedures
Ensuring correctness of coding in the COM
Providing education to UMES management in the accuracy of charges
Analysis and assessment of diverse data relating to the revenue cycle
Providing essential quality evaluation, reports, advice and improvement recommendations to management in all service lines
Understand and communicate complex issues and changes relating to regulatory compliance and third-party reimbursement to the department(s) involved, maintaining records of their notification, accountability and compliance
Assessment of individual and departmental compliance issues and reporting any non-compliance through UMES Service Line structures
Provide accurate, critical information for identification of areas needing immediate attention to expedite compliance, recommend revenue cycle process improvements and collect every dollar owed
Development and execution of training and quality assurance programs for all Patient Financial Services and other revenue cycle functions as assigned