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Revenue Integrity Liaison
Job Summary: The Revenue Integrity Liaison will help ensure the submission of clean, accurate claims that are compliant with coding guidelines, payor requirements and government regulations. The incumbent of this position will maintain the integrity of the revenue capture system for Mary Washington Healthcare. The Revenue Integrity Liaison will interact with other hospital departments to provide assistance in charge capture in their departments.
Essential Functions & Responsibilities: Identifies root causes of edits; collaborates with Patient Financial Services, Corporate Compliance and Clinical Departments to reduce the occurrence of edits.Resolves coding-related claim edits (e.g. CCI, LCD) on outpatient hospital claims.Collaborates with CDM Analyst to resolve charge errors and ensures hospital services are correctly charged and billed appropriately to the patient.Assists in the analysis and resolution of outpatient ancillary denials. Reviews denials to identify trends.Works with departments, operational and business managers to develop and reinforce process improvement activities in the areas of charge capture integration, charge reconciliation, and revenue cycle training.Reviews all observation patient documentation to determine appropriate hours to be billed based on carve outs, in addition to documentation for infusion and injections.Works with Patient Accounting (Denials Billing and Third Party) to identify issues related to denied charges for hospital services.Meets with clinical departments quarterly to communicate variances and opportunities to improve overall charge capture. Assists with updating and providing education support regarding identifying existing charging problems and developing resolutions.Audits charge capture utilizing software tools. Provides feedback to the various departments based on audit results.Performs other duties as assigned. Qualifications: High school or equivalent required.Certified Professional Coder (CPC) certification, Certified Outpatient Coder (COC) or Certified Inpatient Coder (CIC) required.A minimum three years Patient Accounts Billing, Compliance, or Revenue Integrity related work experience is required.Knowledge of general hospital billing processes, medical terminology and coding guidelines is required.Excellent organizational, oral and written communication skills.Familiarity with hospital charging systems and knowledge of CPT, HCPCs, Revenue Codes and Revenue Cycle preferred.Prior experience with Microsoft Excel and Word, Cerner, 3M, MedAssests and/or ICD-10 is preferred.Ability to facilitate education and apply critical and analytical thinking skills is preferred.