Revenue Integrity Supervisor, Physician Billing

Erlanger Health System•Chattanooga, TN

38d

About The Position

The revenue integrity supervisor is a critical role responsible for optimizing professional services revenue, identifying potential revenue leakage while ensuring compliance in charging and billing practices within the healthcare system. Through a combination of data analytics, and process improvement techniques, this role will support the accurate capture of charges, identifying meaningful opportunities to improve and work closely with physician leadership and partnering with compliance to provide education and training. This position will also provide ongoing communication through reports & regular presentations as well as handling intake of requests and potential improvement opportunities. Supervises the revenue integrity team to ensure complete, compliant, and timely professional services charge description master updates for the health system. Leads and supervises the revenue integrity projects related to integration of new specialties or changes in workflow that impact multiple departments. Plans, coordinates, monitors, and manages the workflows ensuring effective and efficient daily operations of the Revenue Integrity team. Provides training and education to employed and contract billable providers regarding charge selection/entry and documentation requirements. Ensures billable charges are captured and oversees data analytics and management reporting.

Requirements

Proficient in hospital and professional revenue cycle operations.
Expert in analyzing revenue data to identify trends and opportunities with the capacity to communicate findings effectively to varied audiences. Ability to analyze revenue data and identify trends and opportunities and the ability to present such data to a variety of audiences.
Adopts a philosophy consistent with Erlanger Health's Mission, Vision, and Values, and models these standards.
Strong interpersonal skills facilitate seamless communication with the clinical staff, and faculty.
Solid understanding of coding conventions and current third-party payer rules and regulations.
Current knowledge of third-party payer rules and regulations.
Knowledge of management and supervision and the ability to organize staff work.
Knowledge and understanding of computers to confidently monitor and obtain information from electronic medical records and database systems.
Ability to work independently and demonstrate problem-solving skills.
Ability to apply critical thinking skills to complex issues and situations.
Knowledge and understanding of the requirements for complete medical records per Erlanger Health Bylaws, rules and regulations, DNV, Federal, State, and regulatory body regulations.
Demonstrates command of written and telephone communication skills.
Ability to maintain confidentiality and adhere to federal, state, HIPAA, and hospital policy in regard to privacy of patient health information.
Organizational skills to effectively demonstrate ability to prioritize during job performance.
Knowledge of window operating systems, Microsoft Office products, Electronic Health Record System, Document Imaging System and office equipment.
High school graduate or equivalent.
CPI Annual/Biannual training if applicable.
Must have working-level knowledge of the English language, including reading, writing, and speaking English.
5 years experience in management of clinical billing or healthcare experience required with extensive knowledge of ICD-10-CM and CPT coding principles.
Good organizational, written, and verbal communication skills.
Certified Professional Coder (CPC), or Certified Outpatient Coder (COC), or Certified Coding Specialist, or Registered Health Information Technician (RHIT), or Registered Health Information Administrator.

Nice To Haves

Associates or Bachelor's degree in business administration, Finance, or related field
Certified Revenue Integrity/Cycle as RCMS, or CHRI, or CRCS.

Responsibilities

Charging Optimization: Conducts prospective and retrospective reviews/audits of charge capture practices in the clinical departments. Reports findings, provide education to both providers and charge capture support staff. Coordinates charge capture improvement tools in collaboration with Revenue Cycle IT teams. Reports on potential compliance issues for further analysis and follow-up to the compliance department.
CDM Optimization: Works to ensure a compliant CDM. Works with existing tools to evaluate CDM requests with focus on regulatory coding, compliance, and adherence to Erlanger internal guidelines regarding CDM maintenance, standard naming conventions and pricing integrity.
Department Education: In collaboration with the compliance department and coding department, provides education to clinical department staff, physicians, APPs, and coder regarding CPT codes, HCPCS codes, revenue codes and modifiers and their compliant use.
Project Management: Leads projects to improve revenue capture, increase inefficiencies in the charge capture process, and reduce provider burden with the charging process.
Financial Analysis: Performs basic financial analysis to report the impact of charge capture practice changes and corrections to current practice.
Issue resolution: Through the combination of EPIC WQs, external edit platforms, and ongoing evaluation, identifies charging issues and works to identify solutions.
Plans, coordinates, monitors, and manages the workflows for Revenue Integrity.
Investigate trends and education to employed and contract billable providers regarding charge capture, charge reconciliation, and billing/coding guidelines.
Assist clinical departments with the deployment and continuous performance improvement efforts, for accurate and compliant charge capture and revenue reporting and analysis and reduce revenue leakage.
Identifies relevant regulatory and contractual terms and maintains standardization among CDM and charge capture processes through the Health System.