NHRMC, established in 1967 in Wilmington, NC, is recognized as a preeminent healthcare organization focused on leading our community to outstanding health. We have an 855 bed network of hospitals and multi-specialty physician group practices with more than 200 physicians. With a network of primary, specialty, neighborhood clinics and regional medical centers; you will find our culture is the very definition of best in practice. Join us and find out how many ways NHRMC offers you the chance to focus on what really matters - our patients and community.
About the Job
Location: NHRMC Business Center A
Department: Coding and Revenue Integrity
Full Time Equivalent: FTE: 1.000000
Work Type: 64 to 80 Hours Pay Period
Work Schedule: STD HRS - Standard-Exe or Office w flex
Exempt from Overtime: Exempt: Yes
What You'll Do
Works under the supervision of the Director of Coding. The Revenue Integrity Coordinator is a self-motivated individual with excellent communication and organizational skills. The Coordinator is responsible for training and orienting new employees and revenue stewards to policies and procedures, processes, and the use of electronic systems. Monitors and coordinates daily workflow, adjusting as needed to ensure financial and quality targets are met. Maintains a high level of billing/charging knowledge, keeping current with ever changing payor policies, guidelines, and regulations. Responsible for researching coding and billing guidelines and disseminating information regarding billing/coding to the appropriate clinical and support departments. Develops and maintains charging policies, procedures, and standard work that support a compliant charging process .Exhibits technical skills necessary for the retrieval, validation and reporting of patient charge data. Performs routine and special project financial analysis to assure revenue integrity at the patient claim level. Conducts routine chart audits and data mining analytics to determine accurate and timely charge capture and regulatory compliance.Reports and recommends actions based on findings. Performs variance analysis as assigned to the daily revenue reconciliation report. Oversees the team of coding reimbursement specialists to support the timely billing of accounts and accurate claim edit resolution. Serves as a SME and assists the CDM Analyst to identify correct CDM billing codes.Exhibits strong problem-solving skills and ability to summarize information.
- Oversees the team of coding reimbursement specialists to support the timely billing of accounts and claim edit resolution. Responsible for training and orienting new employees and revenue stewards to policies and procedures, processes, and the use of electronic systems. Monitors and coordinates daily workflow, adjusting as needed to ensure financial and quality targets are met. Interacts with and serves as a resource to all patient care areas to assist them in the identification and capture of all appropriate patient revenue for services rendered.
- Educates managers/revenue stewards on charge reconciliation policies and procedures, revenue variance reports, low variance reports, daily reconciliation and monthly reconciliation report. Tracks department reconciliation reports and reports results/compliance
- Audits all revenue producing cost centers for daily charge reconciliation at least once every two years, compiles reports results. Performs education as needed for any department that fails audit, creates and implements work plans to resolve identified issues and follow up items
- Serves as a resource to all revenue stewards and throughout institution on billing and charging issues
- Performs daily review of revenue variances for all revenue producing departments.Verifies accuracy and interacts with managers/revenue stewards to assist them in determining the reason for variances in department revenue. Documents and reviews the maintenance of daily revenue reconciliation reports by ancillary departments
- Conducts routine chart audits to determine accurate and timely charge capture and regulatory compliance. Identifies trends, reports findings, develops response and aids Clinical areas in implementing improvements.
- Performs audits of patient records to analyze and improve charging/billing practices of departments, procedures or specific EAP’s as required
- Works with departments to verify CPT and revenue codes are accurate and initiates corrections as necessary, as requested.Investigates for missing supply items and procedures and implements corrective action to ensure accuracy going forward
9.Provides education and supporting information regarding CPT coding, billing, and/or coverage changes to departmental and hospital personnel, as needed
- Collaborates with the appropriate resources and Clinical Subject Matter Experts (SME’s) to maintain the various table files within EPIC which are responsible for providing accurate CPT/HCPCS codes and revenue codes within EPIC, based upon multiple payer requirements
- Notifies departments of changes in billing and charging practices and notifies the appropriate management personnel when coding changes may impact net reimbursement, gross charges, productivity or internal processes.Works with appropriate management to assess and mitigate the impact to NHRMC.
- Researches possible new procedures or regulations at request of department directors/managers
- Assists with the follow up, resolution, appeal and process improvement of clinical and administrative denied claims. Exhibits specific knowledge of payment methodologies including, but not limited to Medicare IP PPS, IPF PPS, IRF PPS, OPPS, Medicaid, and Tricare.
- Maintains billing category tables and cost center assignment tables in EPIC
- Utilizes charge edit and capture software to research and develop improved billing/charging practices
- Maintains EPIC workqueues daily, as assigned, and reviews other workqueues that fall under revenue integrity.Assists revenue stewards with clearing workqueues, or investigating issues, as needed.
17.Works together with the charge master analyst to research appropriate CPT/HCPCS codes and UB revenue codes for supplies and procedures and in determining prices for new services and supplies. Serving as a resource for the identification of CPT and other codes for billing
- Assist with the preparation of financial analysis for new products and technology especially focusing on the needs of the Technology Assessment Committees.
* Cert Coding Specialist
* EPIC Certification
* Bachelors Degree
Education: Bachelor’s Degree is required with a major in HIM, Business, Nursing or related field.
Licensure / Certifications: EPIC certification in charge capture and CDM management or must obtain certification with 2 years of start date. Certified Coding Specialist (CCS), RN, or similar certification is preferred.
Experience: Five to seven years experience in hospital revenue integrity, coding, billing or hospital information systems and or CDM administration. Working experience with Microsoft Excel and hospital patient account data. Knowledge of Access and Hospital Third Party payment mechanisms preferred. Preferred working knowledge of NCCI/LCD billing edits, payor regulations, and OPPS/IPPS. Supervisory experience preferred.
Demonstrates standards of performance (ownership, teamwork, communication, compassion) that support patient satisfaction and principles of service excellence.
Performs other duties as assigned.
Individual will possess commensurate combination of education, experience and qualifications.
This position description has been designed to indicate the general nature and level of work performed by employees within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities and qualifications which may be required of the employee assigned to the position. Depending on the location of the job, duties may vary. Receipt of the job description does not imply nor create a promise of employment, nor an employment contract of any kind; my employment with the Company is at will.
- Member Top 100 Hospitals – In 2016 NHRMC was recognized as a Top 100 Hospital demonstrating significant investment and financial sustainability for the communities we serve.
- Newsweek's 2020 list of Best Maternity Care Hospitals - NHRMC Betty H. Cameron Women's & Children's Hospital was named as a Best Maternity Care Hospital by Newsweek.
- Forbes America’s Best Large Employers 2018 and 2019- Link
- Becker’s 150 Top Places to Work in Healthcare- Link
- Healthgrades Outstanding Patient Experience
Consider a career at NHRMC and become part of this award winning team!