Requires RN license. Facilitates, obtains, reviews and revises accounts to achieve revenue enhancement and compliance.
Educates members of the patient care team regarding documentation guidelines and regulatory requirements. This position updates and reviews accounts to ensure accurate and complete charge capture and accurate, timely billing.
Perform specialized audits of revenue cycle processes.
Document and analyze revenue cycle processes including charge capture and medical documentation.
Compile cost and/or reimbursement reports as requested.
Maintain and provide information on status of audits and issues presented.
Participate in quantifying audit outcomes, including revenue realized.
Research and communicate appropriate capture of charges to clinical managers as discovered.
Research technical guidance in VitalWare, CPT/HCPCs Guide, CMS website, etc. to resolve billing issues and promote regulatory compliance
Participate in required regulatory change implementations and ongoing monitoring related to compliant charge capture.
Work with PFS to resolve billing issues.
Assist in calculating estimate to patients at pre-admission as requested
Act as liaison and resources to PFS staff in answering questions regarding charges, supplies, and nature of service as requested.
Clean up and maintenance of CDMs for OR, PACU and SDS
Work with MM on renaming conventions for supplies/implants
Clinical resource for preference card builds and revisions
Create new procedures for scheduling
Work with the OR scheduler to assign correct level charges in the OR
Participate in inventory reduction processes/goals for Surgical Services and MM as outlined by directors
Assisted in the development and then build, implemented and perform ongoing monitoring of new level charges for OR, GI and minor procedures
Review charges for SDS and after hour infusions to assure maximum charge capture in compliance with CMS regulations
Provide ongoing education for schedulers/billers in OR and SDS
Clinical resource for Chargemaster manager
Participate in Revenue Integrity meetings
Assist in all clinical areas with CDM review and revisions
One of the administrators for VitalWare
Monitor all charges for the PA First Assist and RNFA and work with Case Management, HIM and PFS to develop processes in order to capture charges
Participate in the Quality Measure team as requested
Revised pain procedure dictionaries and charge attachments. Work ongoing with schedulers/billers for accurate billing
Performs related duties as assigned
Montrose Memorial Hospital