Revenue Integrity Senior Analyst
Job ID: 89063
Area of Interest: Information Technology
Location: Linthicum,MD US
Hours of Work: M-F 8a-430p
Job Facility: University of Maryland Medical System
Employment Type: Not Indicated
What You Will Do:
Under limited supervision, identifies charge capture improvement opportunities and works collaboratively with Revenue Integrity staff to develop an annual work plan to ensure process improvement is understood by clinical department managers and staff to ensure expected outcomes associated with charge capture processes. Serves as the conduit between clinical departments and Revenue Integrity.
The Senior Specialist directly reports to the Revenue Integrity Manager for designated service lines within their scope of responsibility. Facilitates implementation of standardized processes and accountability to support efficient and effective charge capture outcomes. Recognized as an HSCRC service line subject matter expert. Proposes, implements, reviews, and modifies all work related to reimbursement methodologies in compliance with HSCRC, federal, state, and local laws/regulations.
Responsible for building relationships with stakeholders and uses critical thinking skills to provide system solutions to meet business needs with the guidance from the leadership team. Manages own time to accomplish tasks with minimal oversight, and serves as a mentor to others on the team. Conducts project management activities as required, and executes projects and deliverables with limited supervisions.
Principal Responsibilities and Tasks
The following statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all job duties performed by personnel so classified.
The Revenue Integrity Senior Specialist should be proficient in Resolute Hospital Billing Charge Description Master; must maintain Epic new version training requirements on an ongoing basis.
1. Oversees the processes to establish, maintain and continuously update and monitor the accuracy of the charge master files, including oversight of annual CPT and quarterly HCPCS updates, compliance to State and Federal billing / compliance regulations.
2. Possesses extensive knowledge and understanding of all charge processes within their designated service lines and provides guidance to staff who assist department managers/directors with determining chargeable services and appropriate CPT/HCPCS coding. Collaborates with clinical department staff to promote compliance with established charge capture and charge reconciliation policies and procedures.
3. Serves as a subject matter expert to assist with system/process setup for new services within their designated service lines. Supports development, implementation and compliance of Charge Capture policies and procedures necessary to support operations.
4. Assists with build, configuration and/ or modifying application build.
5. Proactively assesses revenue capture within their designated service lines, particularly those that are high volume, high revenue, and/or high risk to ensure accurate Charge Capture and provides recommendations for Revenue Cycle process improvements.
6. Works with clinical departments to ensure appropriate charge capture effectiveness and identifies and recommends opportunities for improved standardization and consistency of Charge Capture processes system wide.
7. In conjunction with Revenue Integrity team, participates in service line discussions to understand charge capture workflows and charge triggering logic. Collaborates with Epic Technical Specialists on system software related build. Summarizes findings and the completion and validation or various CDM documentation.
8. In collaboration with Revenue Integrity team, proactively tests system software to ensure billing compliance with all federal and state regulatory policies and requirements
9. Reviews and provides written documentation of various types; application documentation, training manuals, status reports, etc.
10. Provides guidance for workflow design and build as it relates to system enhancement, new releases and upgrades.
11. Collaborates with Revenue Integrity Specialists, Epic Technical Specialists, clinical departments, application analysts, and clinical informatics to ensure that the appropriate ancillary and clinical module charge capture tool(s) are updated appropriately.
12. Provides technical support to fulfill CDM maintenance, reporting and data analysis requests.
13. Responsible for researching HSCRC, State and Federal Regulations and Local Coverage Determinations for all service lines. Distributes final summaries, billing protocols, and training tools as needed.
14. Responsible for the development of system-wide CDM integration and standardization between hospitals CDM master files.
15. Coordinates with the Coding Auditors to assess documentation deficiencies associated with charge capture outcomes and provide necessary education to the clinical teams.
16. Communicates regularly with decision support, financial reporting, hospital departments, health information management (HIM), and others to ensure compliance of all regulations and optimal effectiveness of financial reporting.
17. Seeks opportunities to optimize system software as it relates to charge review work queues, DNBs, and reports. Assists with troubleshooting issues, providing guidance and training or solutions to end users.
18. Demonstrates an understanding of interfaces (i.e., requirements, troubleshooting, testing, etc.) and the ability to train users and create reports and extracts.
19. Provides assigned on-site support during go-lives and system upgrades for their designated service line(s).
20. Stays current on health care and regulatory topics and coaches others to do the same; communicates relevant changes and procedural revisions to management and staff. Implements appropriate departmental operational changes to ensure compliance.
What You Need to Be Successful:
Education and Experience
1. Bachelor’s Degree required. Specialization in Healthcare, Finance, Accounting or equivalent related subject is preferred.
2. Epic proficiency required.
3. CPC Certification obtained within 18 months of being placed in this role.
4. Two (2) to four (4) + years of Revenue Integrity and/or CDM build/maintenance experience.
Knowledge, Skills and Abilities
1. Advanced knowledge of HSCRC, state and federal reimbursement laws and regulations, as well as knowledge of ICD-10 and AMA Current Procedure Terminology (CPT) is required.
2. Highly effective verbal and written communication skills are necessary.
3. Adheres to applications security and control procedures in accordance with departmental, vendor standards, and regulatory bodies.
4. Effective data analytic skills required. Ability to organize, combine, filter, and perform calculations on large datasets.
5. Ability to monitor daily work activities, delegate responsibilities and tasks, evaluate, train and motivate performance of subordinate technical, professional and clerical support staff (if applicable).
6. Proficient organizational and problem-solving skills are required to develop/implement efficient work processes and to successfully resolve difficult, conflict-oriented situations.
7. Knowledge of charge master components, coding and Epic charge master description application.
8. Excellent presentation, interpersonal, and negotiating skills needed to build collaborative relationships with leadership and make formal presentation of findings and recommendations.
9. Ability to handle confidential issues with integrity and discretion.
10. Ability to work effectively in a stressful work environment.
V. Working Conditions/Physical Demands
1. Position may require flexible work schedule, including night and weekend support of major implementations or major system support efforts.
2. Weekend, shift work, holiday and on-call work beyond normal business hours may be required to complete projects, meet deadlines, or respond to emergencies.
3. Work is performed in various environments within UMMS.
4. Work may include regular travel to and from the various affiliated institutions within the Medical System.
5. Work may be required in a Healthcare facility which the observance of “Universal Precautions” is mandated. Universal Precautions involves the wearing of protective clothing/equipment and the observance of safe work practice.
6. Work is high demand and fast paced.
7. Talking and hearing necessary for conversations with UMMS staff members.
We are an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected veteran status, age, or any other characteristic protected by law.
We are an Equal Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected veteran status, age, or any other characteristic protected by law. EEO IS THE LAW