Revenue Integrity Liaison

Serves as the liaison between the revenue cycle management departments and the hospital and ambulatory departments. Responsible for collaborating with department revenue leads and staff to ensure accurate charge capture operations are in place to include daily charge capture, revenue reconciliation and error correction processes. Maintains collaborative relationships with Patient Financial Services, Clinical Departments, and Compliance. Plays an important role with improving revenue results by taking a global view of clinical and financial processes, functions and interdependencies from the provision of patient care to final bill generation.

• Commits to the KRMC mission, vision, values and goals and consistently demonstrates our core values. *Monitors transactions in the charge review work queues and follows up with departments on backlogs, threshold change request and other charge issues. Researches and resolves claim pre-bill edits and pre-bill errors within the assigned queue, including review and correction of the daily assigned DNFB hold claims.Applies NCCI and MUE guidelines to resolve edits appropriately and identify any charging or compliance issues. Coordinates with coding and clinical areas to resolve any identified charging issues.*Responsible for verification and/or correction of billing data for accuracy and completeness by following regulatory requirements and reviewing the medical record.Coordinates findings with hospital departments to ensure missed charges are billed. Collaborates with departments on developing process changes to ensure accurate, compliant and efficient charging practices.*Analyzes the charge review work queues to identifying root causes. Educates clinical staff and department leaders of missed charges or incomplete documentation, which does not support billed charges.*Works with identified clinical and revenue cycle departments to implement compliant process changes.*Meets independently with Directors regarding charging, reconciliation and compliance concerns.*Updates and maintains department charge master as needed including: performing chargemaster maintenance and validating entries; reviewing and assisting with maintenance of chargemaster compliance reports; assisting with other necessary projects to maintain the chargemaster file; and working with clinical areas to update charge master for annual cpt/hcpcs code changes.*Performs patient audits to ensure correct charging and review all external outpatient accounts with external auditors. Leads audit/charge evaluations according to the Director of Revenue Cycle. Meets with departmental leadership to review findings, documentation standards and recommendations for improvement. *Serves as a liaison between Facility Administration, Department Director, and external auditors regarding charging issues, clinical documentation issues, and revenue opportunities. Builds strong relationships and facilitates productive communication between assigned department Directors, Managers, and staff. Collaborates to develop and implement action plans to resolve charge errors.*Reviews CMS transmittals and Local Coverage Determination (LCD) and assesses impact to Revenue Integrity procedures and implement. Regularly reviews literature to identify enhancement to the quality assurance methodology and documentation requirements. *Maintains in-depth knowledge of Medicare and Medicaid billing practices, guidelines, laws and regulations to ensure accurate Medicare and Medicaid billing. Reviews and interprets Medicare Local Coverage Determinations and National Coverage Determinations (LCD and NCD) and applies that to the billing process.*Assists Analytics when justification is necessary for unfavorable metrics. Must have the ability to analyze data in Excel or other Epic tools to help with variance analysis.*Utilizes established reporting analytics to monitor department’s revenue cycle flow.*Maintains billing and coding education, attends webcasts and conference calls as required.Utilizes process improvement by continuously reviewing, recommending and implementing improvement steps; researching regulatory requirements relevant to charges, monitoring trends, and maintaining knowledge of charge-related regulations and standards; and applying knowledge to ensure that charges are accurate, billed correctly, and supportable according to payer and regulatory requirements.Maintains professional growth and development through seminars, workshops, and professional affiliations to keep abreast of latest trends in field of expertise.Participates in meetings, committees and department projects as assigned.

Education And Experience

Associates in healthcare administration or related area preferred. High school graduate or equivalent required. Minimum of five (5) years’ experience in the hospital setting, healthcare industry or coding with a focus in one or more of the following areas: coding, charge, revenue integrity; charge reconciliation; charge compliance; charge auditing; CDM management required. EPIC experience preferred.