Department/Unit:

AMHS Revenue Integrity

Work Shift:

Day (United States of America)

Salary Range:

$64,972.00 - $97,458.00

Under the direction of the Revenue Integrity Manager, this position is responsible for supporting hospital and physician charge capture, and revenue improvement initiatives. Collaborates with coding, billing, clinical, and charge champions to ensure accuracy in charging. Assists in developing and implementing charge capture policies which optimize compliant revenue generation along service lines, Supports compliance efforts by adhering to regulatory, organizational, and departmental guidelines related to charging for services. This position is responsible for managing the revenue cycle reporting, data analysis, database development, information systems implementation and auditing. Duties include evaluating and presenting revenue cycle information, audit finding results and statistical trends.

Essential Duties and Responsibilities

• Exemplifies the AMHS Values and Code of Conduct, while striving to identify compliance risk through effective and timely review of RAC Audit requests, ensuring timely appeals, as appropriate, and reporting any identified risks to Legal Services and Corporate Compliance Departments.
• Ensures immediate action is taken on any issues identified by Legal Services or Corporate Compliance.
• Builds and nurtures collaborative supporting relationships with the AMI-IS executive team, clinical chairs, faculty, clinicians, and other leaders across the health system and encourages, promotes, and advocates staff to ensure integration of new processes across all departments.
• Collaborates with billing and internal stakeholders on initiatives to resolve issues, decrease billing delays and accelerate revenue.
• Monitors the revenue cycle dashboards and other production reports that generation information related to the key performance indicators.
• Identifies deficiencies in processes, impactful trends and missed opportunities to collect revenue.
• Demonstrates knowledge and appropriate use of the hospital systems and serves as a resource to department staff.
• Advises departmental staff and charge champions on proper usage of charge codes based upon medical record analysis.
• Works with hospital departments to implement internal controls when errors are identified.
• Establishes the process to collect, review and analyze revenue cycle metrics data, presents trends, and results to fiscal leadership, and maintains the monthly revenue cycle dashboard.
• Organizes workflow, problem-solves, and manages multiple ongoing priorities with minimal supervision
• Effectively communicates with AMHS leadership, management, and staff, Maintains positive interaction with department staff as required for communication concerning data entry status, completeness, or other information concerns.
• Develops reports to support Service Level agreements to ensure prompt response to issues/concerns leading to improper billing coding and charging
• Creates process to perform and/or support the underpayment analysis and work with Patient Accounting to resolve payment variance
• Identifies and reports opportunities to improve processes, procedures, systems, and/or organizational structures.
• Serves as a liaison with vendors as needed when information relating to data, analysis, and payer processes is involved.
• Keeps current with industry knowledge, including but not limited to healthcare payers, changing requirements (e.g. authorizations, billing, and reimbursement); sources and attends training sessions as needed to maintain knowledge.
• Acts as source of reference for enterprise on regulatory, reimbursement or billing changes, and develops and implements training to maintain and support compliance with federal and state regulations.
• Maintains a working knowledge of revenue cycle process to aid in the implementation of regulatory standards that assist compliant charge capture practices.
• Monitors compliance with corporate, federal, and state guidelines to include review of commercial bulletins for HCPCS/CPT code changes and additions and billing unit rule changes.
• Other duties as assigned.

Qualifications

• Associate's Degree in HIM, healthcare finance or a related discipline - required
• Three years of experience in hospital clinical and financial data, and expertise working with these complex relationships to produce solutions that ensure appropriate charge capture - required
• Epic experience - preferred
• Possess a strong theoretical and practical working knowledge; along with, experience of how a healthcare Revenue Cycle eco-system should work (best practice)
• Advanced skills using Microsoft Excel, PowerPoint, Word, Access
• Strong independent worker with known ability to prioritize and escalate tasks as required
• Demonstrated ability to manage multiple priorities and meet all established deadlines
• Excellent verbal and written communication skills
• Knowledge and expertise across all aspects of healthcare revenue cycle functions, including registration, coding and documentation standards, billing, and collection processes and payor regulations
• Demonstrated ability to identify data and analytic challenges including data integrity, appropriateness of data sample, and consistency between sources
• Experience with fully leveraging the power of analytic tools to develop trends and establish dashboards
• Knowledge of CMS local, state, and federal regulatory and the various data elements associated with all types of claim forms
• Certified Revenue Cycle Representative (CRCR), CPC, CCS, or other coding credential - preferred

Equivalent combination of relevant education and experience may be substituted as appropriate.

Physical Demands

• Standing - Occasionally
• Walking - Occasionally
• Sitting - Constantly
• Lifting - Rarely
• Carrying - Rarely
• Pushing - Rarely
• Pulling - Rarely
• Climbing - Rarely
• Balancing - Rarely
• Stooping - Rarely
• Kneeling - Rarely
• Crouching - Rarely
• Crawling - Rarely
• Reaching - Rarely
• Handling - Occasionally
• Grasping - Occasionally
• Feeling - Rarely
• Talking - Constantly
• Hearing - Constantly
• Repetitive Motions - Frequently
• Eye/Hand/Foot Coordination - Frequently

Working Conditions

• Extreme cold - Rarely
• Extreme heat - Rarely
• Humidity - Rarely
• Wet - Rarely
• Noise - Occasionally
• Hazards - Rarely
• Temperature Change - Rarely
• Atmospheric Conditions - Rarely
• Vibration - Rarely

Thank you for your interest in Albany Medical Center!

Albany Medical Center is an equal opportunity employer.

This role may require access to information considered sensitive to Albany Medical Center, its patients, affiliates, and partners, including but not limited to HIPAA Protected Health Information and other information regulated by Federal and New York State statutes. Workforce members are expected to ensure that:
Access to information is based on a “need to know” and is the minimum necessary to properly perform assigned duties. Use or disclosure shall not exceed the minimum amount of information needed to accomplish an intended purpose. Reasonable efforts, consistent with Albany Medical Center policies and standards, shall be made to ensure that information is adequately protected from unauthorized access and modification.

Thank you for your interest in Albany Med Health System!​

Albany Med Health System is an equal opportunity employer.

This role may require access to information considered sensitive to Albany Med Health System, its patients, affiliates, and partners, including but not limited to HIPAA Protected Health Information and other information regulated by Federal and New York State statutes. Workforce members are expected to ensure that:

Access to information is based on a “need to know” and is the minimum necessary to properly perform assigned duties. Use or disclosure shall not exceed the minimum amount of information needed to accomplish an intended purpose. Reasonable efforts, consistent with Albany Med Health System policies and standards, shall be made to ensure that information is adequately protected from unauthorized access and modification.