This position is responsible for maintaining the integrity of the Lurie Childrens revenue capture system. The Hospitals annual revenue currently exceeds one billion dollars. Maintaining an accurate and legally compliant charge capture system is a challenging position and critical to the fiscal strength of the Hospital. More specifically, the focus of this position is to:
1. Establish an appropriate charge structure consistent with industry standards, local market conditions and Lurie Childrens contracts;
2. Maximize collections through the accurate and complete capture of all charges;
3. Vigilantly monitor charges for inaccurate and/or inappropriate postings;
4. Provide education of key revenue department managers and directors as to their roles and responsibilities in the revenue capture process; and
5. Support Lurie Childrens corporate compliance program by verifying that the charge master and charge usage is in compliance with all applicable regulatory guidelines and that Hospital staff adheres to approved charge posting policies and procedures.
The ideal candidate will have a clinical background, revenue integrity, or minimally coding or nursing background.
1. Ensures the accuracy and integrity of the revenue capture system across the Hospital. Works with department managers to develop and implement policies and procedures, and Epic tools for purposes of reconciling charges posted in the billing system with other measures and sources of information.
2. Identifies opportunities for charge capture improvement through the implementation of routine and random monitoring. Develops tools designed to track and identify potential areas of lost revenue. Looks for opportunities to utilize Epic software to better manage the charge capture system taking into account how the system works operationally with other Hospital systems.
3. Develops, maintains and enhances the charge structure of revenue generating departments to assure that charges accurately reflect services and supplies provided and are structured consistent with current industry accepted practices. Maximizes collections through ongoing analysis of claims considering terms and conditions of Lurie Childrens payor contracts. Makes recommendations to Lurie Childrens contracting department regarding terms and conditions and charge increases giving consideration of improving payments from third party payors.
4. Oversees implementation, maintenance and enhancement of charge master. Reviews and approves changes in pricing, CPT codes, HCPCS codes and Revenue codes for accuracy and compliance to all applicable billing guidelines and optimization of reimbursement. Acts as a resource to revenue generating departments in establishing new charges using appropriate procedure codes. Determines the reimbursement impact of CPT code revisions as well as charge additions and deletions.
5. Maintains currency in regulatory issues that affect billing and compliance and educates directors and managers regarding potential changes in coding and billing regulations. Maintains currency with all regulatory issues affecting billing, reimbursement and compliance.
6. Trains managers of revenue generating departments in the management of their respective section of the charge master. Ensures coordination of coding between HIM and Patient Financial Services.
7. Undertakes special projects such an annual charge increase analysis, specific department restructuring (e.g., Emergency Department, Operating Room and Pharmacy), and outpatient hospital/physician billing distribution.
8. Work closely with entities under the Medical Center and Epic applications to improve the accuracy of the Hospital and physician groups billing effort.
9. Identifies potential compliance vulnerabilities and collaborates with Compliance, Legal and others as indicated.
10. Coordinates activities related to contractor audit activity (RAC) to ensure timelines are met and ensure appropriate coordination in the organization.
11. Leads the Revenue Integrity Committee, a multidisciplinary committee that addresses strategic pricing, new department build, and other controversial matters
12. Manages the Correct Coding Initiative (CCI) and Medically Unlikely Edits (MUE) process for the organization.
13. Performs job functions adhering to service principles with customer service focus of innovation, service excellence and teamwork to provide the highest quality care and service to our patients, families, co-workers and others.
1. Bachelor's degree in Nursing or other clinical discipline, Bachelors degree in Business, Finance, Accounting or related field is required. Advanced degree or credential in Business or Accounting such as CPA or MBA preferred.
2. Certification in billing and coding represented by any of the following: RHIA, RHIT, RN, CPC, CPC-H, CCS, or CCS-P. Coding skills to include in depth knowledge of CPT, HCPCS, ICD-9 and understanding of regulatory issues. Certification in Epic Charge Capture preferred.
3. Minimum of five years of clinical healthcare experience.
4. Working knowledge of financial statements and ability to analyze financial information and determine financial impact of possible changes.
5. Solid understanding of the information systems used in the billing and collection process.
6. Ability to integrate the financial, clinical, and coding processes to improve compliance and maximize reimbursement.
7. Ability to take initiative by identifying problems, conceptualizing resolutions to the problems, and implementing change.
8. Maintains a current working knowledge of Federal and State regulations
9. Oversee and direct subordinates.
10. Strong comfort level with computer systems.
11. Strong writing and communication skills.