Manager, Revenue Integrity

at NorthShore University Health System in Skokie, Illinois, United States

Job Description

Position Highlights:
Position: Manager, Revenue Integrity
Location: 4901 Searle Parkway, Skokie, IL
Full Time
Hours:Standard business hours, Monday-Friday

What you will do:
Operations and Monitoring
In collaboration with the AVP, Revenue Cycle, analyzes CMS's and the OIG's Annual Workplan and the OIG's Semi-Annual Reports to determine areas at risk for a government coding/billing audit. Prioritizes education based on the internal analysis performed and approval from the Corporate Compliance Office.
Monitors HCPCS/CPT changes proactively by performing billing and CDM reviews in collaboration with the Billing and CDM teams, prior to claim submissions. Problem solves any potential billing errors and makes recommendations for change to all impacted areas.
Develops financial impact analyses reports based on, billing changes, and/or as needed to support revenue cycle changes.
Coordinates charge corrections with the HBO and HIRS as necessary to ensure correction is performed and refund is processed by the HBO to government or third party payors.
Collaborates with the Director Coding Compliance, HIRS, Billing, and Rejection/Denials areas to review and trend government and third party payer letters, such as, but not limited to - CERTs, ADRs, Provider Profile Reports.
Partners with Patient Financial Services to identify trended reimbursement practices that negatively impact revenue and best resolution for identified issues.
Coordinates regulatory oversight of hospital billing and coding activities.

Coding and Billing Education
Provides coding education with physicians, mid-level providers, nursing staff, HIRS coding personnel or hospital department management based on internal analysis performed by the Revenue Integrity and Billing Department. Works with providers and/or staff to develop documentation and coding improvement plan. Maintains database of all education sessions
Collaborates with Internal Audit to plan and implement education sessions on the audit process, medical record documentation criteria, coding compliance or DRG Assurance.
Researches government billing regulations, third party payor guidelines, prospective payment systems, ICD-10-CM and CPT/HCPCS coding guidelines to proactively educate departments impacted by changes.
Researches hospital coding and/or billing questions for HIRS coding and hospital billing office staff. Maintains database of all questions and answers from the coding help-line.
Investigates coding opportunities and implications, Medicare and managed care regulations/guidelines, reimbursement, available technological support, and potential revenue impact. Maintains a current open and closed issues list, assigns responsibilities and timeframes, follows up with responsible parties, and ensures ongoing, valuable, and tangible progress on resolution of issues.
Maintains updates on Medicare Regulatory Changes and provide education to the Hospital and Medical Group

Compliance:
Responds to and investigates hospital compliance concerns as assigned by AVP, Revenue Cycle or Internal Audit. Collaborates with appropriate parties to develop and monitor a corrective action plan. Determines if additional education is necessary and coordinates in-services with the appropriate management team
Reports compliance concerns to AVP, Revenue Cycle or Internal Audit as appropriate and in accordance with NorthShore University HealthSystem's Corporate Compliance Program.
Abides by all of the applicable policies, procedures and guidelines of NorthShore University HealthSystem and assists in the administration of the NorthShore University HealthSystem Corporate Compliance Plan by creating awareness with direct staff.
Ensures that actionable items are resolved in a timely or moved to a higher level within the corporate structure of NorthShore University HealthSystem to ensure resolution, including to the Corporate Compliance Office as appropriate.
Agrees to prepare and provide data and/or aggregate reports in preparation of the Corporate Compliance Committee or as requested by the Corporate Compliance Office.

Charge Capture Management
Assists the Chargemaster Team with identification of new CPT/HCPCS codes to ensure billing systems are updated annually.
Participates in the encounter form, super bill, charge capture tools (order entry forms) annual and ad hoc updating process as assigned.
Collaborates with Hospital Rev Cycle and Medical Group teams on new procedures and emerging technology, working with vendors and payers on analysis for reimbursement.
Monitors department charge reconciliation reports to identify charge capture opportunities.
Works with Epic Application Coordinators to assist with annual ICD-10 coding systems build and smart set documentation template tools.

What you will... For full info follow application link.

EOE: Race/Color/Sex/Sexual Orientation/ Gender Identity/Religion/National Origin/Disability/Vets, VEVRRA Federal Contractor.