The Revenue Capture Specialist works within their assigned departments to insure revenue capture and optimization through charge master reviews, audits and reconciliation of charges. This position reports to the direct leadership of Revenue Integrity department.
NAH reserves the right to make hiring decisions based in part on applicants' state of residence if outside the state of Arizona
ResponsibilitiesTechnical and Critical Thinking Functions
* Reconciles schedule of daily accounts to ensure that all charges are captured in the Accounts Receivable system
* Reviews charges posted to ensure accuracy for type of case, type of procedure, coding/billing rules and edits charges as appropriate.
* Maintains and updates charge screens in the Electronic Medical Record system. Also maintains any other charging methodology by department.
* Follow up on late charges and write-offs by reviewing reports weekly to determine that revenue is appropriate.
* Researches any deviation to expected revenue and proposes solution.
* Maintains department charge master files. Reviews charge master every six months and submits changes as appropriate.
* Works with department manager and Revenue Integrity Manager to ensure proper pricing, description codes and coding for new procedures or changed procedures.
* Audits medical records against charges and claims for improvements in charge capture and documentation.
* Accurate understanding and interpretation of medical records, hospital bills and charge master to ensure high-performing revenue capture.
Communication Function
* Responds to queries regarding department charges, providing responses and explanations and any information needed.
* Identifies areas of improvement, prepares summary of findings to department manager and Revenue Integrity Manager and educates department staff as appropriate per managers' approval.
* Represents department(s) with any compliance audit as needed.
* Develops and maintains effective relationships among internal/external stakeholders, colleagues and staff in order to build trust and facilitate individuals/teams through change initiatives.
Quality and Education Function
* Reviews department medical record documentation on a quarterly basis for improvement opportunities.
* Ensures knowledge and understanding of governmental and accreditation body standards for documentation of department's services and coverage.
* Makes monthly observations and recommendations to prevent future revenue losses.
Compliance/Safety
* Responsible for reporting any safety related incident in a timely fashion through the Midas/RDE tool; attends all safety related training programs; performs work in a safe manner; monitors work environment for possible safety issues and ensures others are also performing work in a safe manner.
* Maintains confidentiality of all department, patient, and billing matters.
* Completes all company mandatory modules and required job specific training in the specified time frame.
* Stays current and complies with state and federal regulations/statutes and company policies that impact the employees area of responsibility.
* Meets industry standard measures of productivity and accuracy.
QualificationsEducation
High School Diploma or GED- Required
Certification & Licensures
Certified Coding Associate or equivalent (CPC/CSS/CCA/RHIT/RHIA/CPMA) - Preferred
Experience
3 years' experience in the healthcare industry with an in-depth understanding of clinical areas - Required
Medical coding and documentation review experience - Preferred
Attention to detail, ability to work independently, ability to efficiently and accurately prioritize varying workload, strong qualitative, analytical and organization skills - Required
Understanding of ancillary department functions, excellent communication skills to interact effectively with public and hospital staff, and positive attitude to work effectively with department staff - Required
Healthcare is a rapidly changing environment and technology is integrated into almost all aspects of patient care. Computers and other electronic devices are utilized across the organization and throughout each department. Colleagues must have an understanding of computers, and competence in using computers and basic software programs.
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