Keck Medicine of USC
The Clinical Revenue Integrity Manager will manage the charge capture team and support unit and the area specific charge capture of clinical services and procedures. Clinical Revenue Integrity Manager is also responsible for communicating missing or incomplete clinical documentation and charge entry errors for clinical department process improvement.
The Clinical Revenue Integrity Manager delivers direction to the documentation of all policies and procedures regarding charge capture and CDM Maintenance; and conducts meetings to evaluate department charge processes to improve charge capture and coding compliance.
Responsibilities
Perform maintenance to the Keck Medical Center of USC Charge Description Master (Keck & Norris) ensuring all annual updates required by Medicare and other third-party payers are up to date. Oversees the reviews and process requests for new code additions, code set corrections, revenue code to CPT/HCPCS code mismatch corrections and on-going identified changes for current systems to maintain compliance with both state and federal regulatory agencies. Manage the charge capture team to ensure that coordinators are accountable to organizational and departmental policies including ensuring high integrity in executing charge methodologies. Lead and Conduct meetings with Operations Leaders, Revenue Auditors, Clinical Department Staff, and Gatekeepers to address issues involving compliance with government regulations, third party payor needs and industry standards. Provide leadership and guidance to the Revenue/Chart Audit team associated with research and resolution of account issues related to the CDM, charge capture, and other issues considered to be revenue integrity. Synchronize CDM data between CDM and CDM Workflow & Management Tool for Keck Medical Center of USC entities on a monthly basis. Provide CDM data as necessary based on identified issues in form of ad-hoc reports. Performs other duties as assigned. Required Qualifications
Bachelor's Degree in healthcare related field. 5 years Experience in medical coding/ Chargemaster experience in a healthcare environment required. 1 to 2 years' of progressive lead/ supervisorial experience. Experience with inpatient and outpatient billing requirements (UB-04) and CMS Medicare reimbursement methodology. Knowledge of other government and third party payer reimbursement methodology required. Must be able to implement a systematic, self-motivated approach to problem solving and be able to identify, coordinate and optimize resources needed to execute plans. Excellent analytical, problem-solving, planning and evaluation skills. Demonstrates ability to utilize effective, appropriate and diplomatic oral and written communication skills. Preferred Qualifications
Previous hospital Chargemaster experience, including the use of CDM Maintenance software (Craneware or Med Assets). Experience and knowledge of Hospital charging practices. Working knowledge of CPT, HCPCs and ICD9 coding principles. Healthcare operations experience, particularly in an acute care hospital setting. Supervisory experience. Current knowledge of the Revenue cycle, specifically the flow of charges in and across hospital billing systems. Required Licenses/Certifications
Registered Nurse - RN (CA Board of Registered Nursing) Or Coding Credentialing from AHIMA or AAPC (CPC, CIC, COC or Certified Auditor (CPMA)) obtained within 1 year of employment or in position. Fire Life Safety Training (LA City) If no card upon hire, one must be obtained within 30 days of hire and maintained by renewal before expiration date. The annual base salary range for this position is $110,240.00 - $181,896.00.
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Perform maintenance to the Keck Medical Center of USC Charge Description Master (Keck & Norris) ensuring all annual updates required by Medicare and other third-party payers are up to date. Oversees the reviews and process requests for new code additions, code set corrections, revenue code to CPT/HCPCS code mismatch corrections and on-going identified changes for current systems to maintain compliance with both state and federal regulatory agencies. Manage the charge capture team to ensure that coordinators are accountable to organizational and departmental policies including ensuring high integrity in executing charge methodologies. Lead and Conduct meetings with Operations Leaders, Revenue Auditors, Clinical Department Staff, and Gatekeepers to address issues involving compliance with government regulations, third party payor needs and industry standards. Provide leadership and guidance to the Revenue/Chart Audit team associated with research and resolution of account issues related to the CDM, charge capture, and other issues considered to be revenue integrity. Synchronize CDM data between CDM and CDM Workflow & Management Tool for Keck Medical Center of USC entities on a monthly basis. Provide CDM data as necessary based on identified issues in form of ad-hoc reports. Performs other duties as assigned. Required Qualifications
Bachelor's Degree in healthcare related field. 5 years Experience in medical coding/ Chargemaster experience in a healthcare environment required. 1 to 2 years' of progressive lead/ supervisorial experience. Experience with inpatient and outpatient billing requirements (UB-04) and CMS Medicare reimbursement methodology. Knowledge of other government and third party payer reimbursement methodology required. Must be able to implement a systematic, self-motivated approach to problem solving and be able to identify, coordinate and optimize resources needed to execute plans. Excellent analytical, problem-solving, planning and evaluation skills. Demonstrates ability to utilize effective, appropriate and diplomatic oral and written communication skills. Preferred Qualifications
Previous hospital Chargemaster experience, including the use of CDM Maintenance software (Craneware or Med Assets). Experience and knowledge of Hospital charging practices. Working knowledge of CPT, HCPCs and ICD9 coding principles. Healthcare operations experience, particularly in an acute care hospital setting. Supervisory experience. Current knowledge of the Revenue cycle, specifically the flow of charges in and across hospital billing systems. Required Licenses/Certifications
Registered Nurse - RN (CA Board of Registered Nursing) Or Coding Credentialing from AHIMA or AAPC (CPC, CIC, COC or Certified Auditor (CPMA)) obtained within 1 year of employment or in position. Fire Life Safety Training (LA City) If no card upon hire, one must be obtained within 30 days of hire and maintained by renewal before expiration date. The annual base salary range for this position is $110,240.00 - $181,896.00.
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