Roanoke ,VA, US, 24011
How You'll Help Transform Healthcare:
This position is responsible for reviewing proposed and final regulatory notices and coordinating with clinical and financial areas any changes needed related to these regulatory mandates. These mandates, if incorrectly implemented or not implemented at all, can result in substantial lost revenue and/or compliance issues for Carilion Clinic. Identifies trends and assists leadership in development of process improvement plans and provider education. Manages statistical tracking, the creation of spreadsheets and serves as a data resource for other departments.
• Stays informed of proposed and finalized regulatory changes. Works with clinical, financial and/or billing areas, to determine how the policy/coding changes affect Carilion Clinic from compliance, financial and/or operational perspectives.
• Assumes responsibility for conducting a financial and operational review of the proposed reimbursement changes and correct coding initiatives. Analyzes the financial impact with management. Develops appropriate communications and coordinates with all departments impacted.
• Interprets the rules, guidelines and further researches with the appropriate third party payor when questions are not readily answered. Takes responsibility for obtaining and coordinating communication of substantiated payor guidelines and assists with implementing changes.
• Assesses the value of adding new services and understands what payor denials may follow billing processes. Understands and explains when/why medical necessity/authorization of services is so critical to securing reimbursement.
• Serves as a liaison for payor escalation issues. Identifies payor trends through monitoring and reporting systematic issues to management. Develops action plans when appropriate and in conjunction with leadership requests.
• Serves as a subject matter expert (SME) on billing operation applications, and educates/communicates business rules created around the billing processes as necessary.
• Performs special project activity as requested or suggests and volunteers to lead process changes. Maintains documentation for future reference that is inclusive of identified issues and resolution/action taken. Analysis, feedback and making recommendations are common components for this role with an end goal of creating better processes.
• Promotes Carilion Clinic's Culture of Excellence and quality service through team work, respectful communication, maintenance of a professional environment, partnership with those we serve and anticipation of customer needs.
What We Require:
Education: Associate's degree preferred, with 3 - 5 years of experience in healthcare related field. Bachelor's degree preferred.
Experience: 3 -5 years experience working with healthcare billing, coding, medical documentation, and/or charge master. Must have an extensive background in CPT and HCPS coding, third party billing and reimbursement, APC reimbursement and CMS regulations, to ensure compliance. Must be proficient with data base programs, Excel, Word, Access, or other data base software and internet based systems.
Licensure/certification: CPC certification, EPIC proficiency gained in the billing/charge master arena within first year. Has, or will obtain within 1 year, Certified Compliance Technician (CCT) certification or other related healthcare financial/clinical certifications to establish skill set for the position.
Other Minimum Qualifications: Demonstrated ability to work with minimal supervision. Work in a confined area under pressure to meet deadlines with frequent interruptions. Attention to detail is imperative, as errors could result in serious financial loss as well as affect hospital integrity and compliance. Must be able to read, interpret, apply and distribute to appropriate personnel, regulations and information obtained from various state and federal sources. Familiar with Information Services map through the Charge Master and to the patient's bill. Excellent communication skills are required to facilitate meetings, and gather information needed for project related work. Work independently and use good judgment when making decisions/recommendations regarding changes to Charge Master. Excellent time management and organizational skills, with the ability to function in a high volume work setting with changing priorities. Reflect professional attitude in a teamwork environment. Work may require attendance at early morning or evening meetings.
About Carilion
This is Carilion Clinic ...
An organization where innovation happens, collaboration is expected and ideas are valued. A not-for-profit, mission-driven health system built on progress and partnerships. A courageous team that is always learning, never discouraged and forever curious.
Headquartered in Roanoke, Va., you will find a robust system of award winning hospitals, Level 1 and 3 trauma centers, Level 3 NICU, Institute of Orthopedics and Neurosciences, multi-specialty physician practices, and The Virginia Tech Carilion School of Medicine and Research Institute.
Carilion is where you can make your own path, make new discoveries and, most importantly, make a difference. Here, in a place where the air is clean, people are kind and life is good. Make your tomorrow with us.
Requisition Number: 144434
Employment Status: Full time
Location: CASB - Carilion Administrative Services Building
Shift: Day
Shift Details: M-F 8:00-4:30
Recruiter Email: kagonce@carilionclinic.org
For more information, contact the HR Service Center at 1-800-599-2537.
Equal Opportunity Employer
Minorities/Females/Protected Veterans/Individuals with Disabilities/Sexual Orientation/Gender Identity
Carilion Clinic is a drug-free workplace.
Please see job description
PI234753258