Physician Revenue and Billing Compliance Coordinator

ThedaCare•Neenah, WI

24d•Onsite

About The Position

The Physician Revenue and Billing Compliance Coordinator partners with clinical, revenue cycle, compliance and finance departments to effectively monitor, communicate, and implement compliant billing practices. This role is the subject matter expert in regulatory and payer policies and is responsible to implement regulatory and payer policy changes, investigate billing requirements needed to support new clinical services, manage and mitigate escalated payer denials, perform timely resolution of payer audits, and design sustainable charge capture and reconciliation protocols.

Requirements

Minimum 5 years of progressive experience in revenue cycle or healthcare compliance with 3 years specific to physician billing and coding and a nationally recognized physician coding certification.
Strong understanding of billing, coding, regulatory and payor policies including telehealth billing requirements across commercial and government payers.
A collaborative and proactive problem-solver with exceptional communication, presentation and interpersonal skills.
Excellent investigational skills.
Proven ability to work independently.
Strong Excel and PowerPoint skills.
Demonstrates excellent time management with the ability to prioritize and thrive in a fast paced, growth environment.
Knowledge of healthcare regulations and compliance requirements.
Experience with Epic practice management system.

Nice To Haves

Bachelor’s degree in HIM, Healthcare Administration, Business, Finance, or a related field.

Responsibilities

Researches and provides billing guidance to support operational leaders in the implementation of new services and charge codes.
Identifies opportunities to ensure accurate and comprehensive charge capture.
Monitors, communicates and assists all functional departments with the implementation of payer and regulatory policy changes.
Understands, monitors and effectively partners with clinical and revenue cycle leaders to ensure accurate telehealth billing and reimbursement.
Collaborates with compliance and revenue cycle functional areas to audit professional claim accuracy.
Monitors and resolves charge router errors.
Monitors and partners with clinical leaders to ensure charge reconciliation is maintained.
Monitors Revenue Cycle AI solutions to ensure compliance and accuracy.
Researches regulatory and payer policies to assist in the appeal process of global denial trends.
Manages payer denial trends to ensure timely resolution or escalation.
Monitors and ensures timely resolution of government payer audits. Collaborates with compliance team to communicate volumes and escalations.
Owns payer portal administration.
Other duties as assigned.