General Summary
Coordinates and directs the corporate Revenue Integrity Team. Serves as a leader in the revenue cycle and is responsible for supporting the revenue capture processes by partnering with the clinical management within the health system. Provides technical expertise, coaches and ensures the accuracy of all charge master data elements such as CPT, HCPCS and revenue codes. Supports the integration of a system wide charge description master and charge capture efforts. Formulates and defines system scope and objectives based on both user needs and a good understanding of applicable business requirements to support the business strategies, strategic vision and goals of the System.
Duties and Responsibilities
Essential Functions:
Provides direct oversight and maintenance of system wide charge description master.
Provides leadership and direction to Revenue Integrity staff.
Drives process optimization across health system for integration of charges between clinical and financial systems.
Directs and participates in complex projects related to revenue cycle initiatives.
Validates and educates clinical service areas on appropriate charging protocols in accordance with regulatory requirements.
Analyzes data for root cause analysis on complex charge capture design issues. Utilizes software maintenance and report writing tools, as required.
Based upon extensive knowledge, validates the use of CPT/HCPCS/UB04 revenue coding, modifiers, CMS billing regulations, and APCs as appropriate.
Acts as clinical/coding expert for Revenue Integrity staff.
Implements related organizational initiatives in a manner that is inclusive and participatory.
Performs charge capture audits as necessary.
Monitors department's key performance indicators for both hospital and professional service areas.
Supports and manages expansion of revenue cycle enhancements to support health system growth.
Reduces denials, improves billing accuracy, and strengthens charge capture workflow performance.
Educates providers and leaders on documentation, coding, and charge capture requirements.
Implements charge workflows within Epic to prevent missed/late charges.
Leads the development, oversight and optimization of Epic Revenue Guardian checks to proactively identify missing or inaccurate charges before claims are submitted.
Common Expectations:
Maintains and/or creates policies and procedures and objectives related to charge capture policies and procedures
Continuously updates information technology skills and knowledge and maintains professional growth and development.
Extensive knowledge of charge creation, regulations, charge capture and reconciliation in a health care environment.
Selects, trains/orients, assigns department staff, evaluates performance, and makes recommendations for personnel actions.
Coordinates and integrates services of teams, with other departments/service lines/entities, and with the System's primary functions. Participates in the selection of outside services (if needed).
Is responsible and accountable for the department's budget.
Continuously assesses and improves teams. Maintains appropriate quality control/assessment programs (if applicable).
Maintains appropriate records, reports, and files as required.
Provides outstanding service to all customers; fosters teamwork; and practices fiscal responsibility through improvement and innovation.
Qualifications
Minimum Education:
Bachelors Degree Required
Work Experience:
5 years Charge master maintenance management experience with some personnel management experience. Required and
Must have a good understanding of the functionality of patient charges and the relationship between the CDM and the revenue cycle. Required
Licenses:
Certified Coding Specialist Upon Hire Required or
Certified Professional Coder Upon Hire Required
Knowledge, Skills, and Abilities:
Must have a good understanding of the functionality of patient charges and the relationship between the CDM and the revenue cycle.
Able to work well in a team environment as a member and/or leader.
Able to accept responsibility.
Thorough knowledge of relevant specialty areas.
Analytical and logical approach to solving problems.
Clarity and discipline in communication skills- written and verbal.
Capable of imaginative and abstract reasoning.
Advanced trouble shooting skills.
Self reliant and capable of independent work.
Proficient in Epic Hospital Billing (HB) and Professional Billing (PB), with advanced knowledge of charge capture workflows, claim generation, reconciliation, and billing edits to support accurate and compliant revenue capture.
Benefits Offered:
Comprehensive health benefits
Retirement savings plan
Paid time off (PTO)
Education assistance
Financial education and support, including DailyPay
Expanded Paid Parental Leave
For additional details: Benefits & Incentives | WellSpan Careers (joinwellspan.org) (https://www.joinwellspan.org/benefits/)
Quality of Life
Founded in 1741, the city of York is considered by many as the first capital of the United States. The Articles of Confederation were signed by the Second Continental Congress here in 1777. Its beautifully restored historic district is an architectural treasure. While York retains its farming and manufacturing heritage, at its heart York is a thriving cultural community that has attracted creative talent and innovative entrepreneurial investors from across the nation.
Life in York County offers affordable housing, options for higher education, a thriving arts and cultural community, historical attractions, parks and recreational resources, semi-professional baseball team, fine dining and more - within an easy drive of major East Coast cities.
York County residents can find local employment in healthcare, manufacturing, technology, agricultural and service sectors. (Patient population: 445,000)
WellSpan Health is an Equal Opportunity Employer. It is the policy and intention of the System to maintain consistent and equal treatment toward applicants and employees of all job classifications without regard to age, sex, race, color, religion, sexual orientation, gender identity, transgender status, national origin, ancestry, veteran status, disability, or any other legally protected characteristic.
