- Overseeing revenue cycle operations for Department with the goal of maximizing revenue by implementing recommended processes and functions in compliance of internal controls.
- Reviews charge activity work queues and releases charges from Epic to payers in compliance with Charge Description Master (CDM) with a focus on appropriate capture and reporting of revenue.
- Analyzes, supports and follows up on complex revenue integrity initiatives.
- Provides Foundation subject matter expertise for insurance.
- Assist front end staff on insurance and organizational revenue integrity and charge capture policies and procedures.
- Coordinates new Attending and Fellow billing and coding training.
- Act as the single point of contact for billing compliance and insurance audit escalations as well as annual billing and insurance plan updates.
- Provide subject matter expertise for contracting and pricing fee schedule updates, plan enrollment and non-covered benefit.
- High School Diploma / GED
- 5 years of experience within a hospital or healthcare billing setting
- Certified Professional Coder
- Knowledgeable in revenue cycle operations
- Familiar with insurance company processes and procedures
- Ability to work with key stakeholders to optimize revenue cycle operations
- Ability to train new staff with limited insurance knowledge on medical insurance
- System proficiency with Epic, Powerchart, QCC, 3rd party insurance company websites, and clearing houses
- Knowledgeable in Current Procedural Terminology, and ICD-10 diagnosis coding (CPC certification)
- Ability to work in a deadline driven environment
- Ability to manage billing compliance for department of 25 health care providers
- Ability to clearly communicate complex medical information both verbally and in writing
- Skill in working with families to understand bill and educate about medical billing while deescalating complaints
- Knowledgeable in key performance indicators of revenue cycle such as accounts receivable and payer mix
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Revenue Integrity Specialist - Boston, United States - Boston Children's Hospital
Description
Job Posting DescriptionThis Revenue Integrity Specialist will be responsible for:
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