Company :

Allegheny Health Network Job Description :

GENERAL OVERVIEW

: This position performs reporting and analysis of the revenue cycle for monitoring and problem resolution; assists staff with internal and external system issues, audits and questions relative to accounts receivable; acts a primary liaison with other parties to resolve system issues and ensure compliance with all regulations; participates in department/system initiatives involving testing and other activities to ensure overall goals are met. Collaborates with facility/department leadership on a continuum basis. Activities include analysis (including root cause), monitoring & auditing, reporting & education with regards to Revenue Cycle training & problem resolution with all level of leadership including physicians, service line VP's, CAO's, CFO's etc. Establishes and implements appropriate internal controls to achieve complete and accurate documentation & billing processes; collaborates and helps to optimize clinical documentation through analysis and prioritized evaluation. Assists with maintaining the integrity of the CDM (charge description master) and the software program.

ESSENTIAL RESPONSIBILITIES

: + Responsible for financial, statistical and operational projects; present detailed analysis of A/R performance and other financial reports and related outcomes/trends; researches and validates clinical data used to support medical necessity of billed services, conducts quality assurance reviews of various billing components, technical requirements, supporting processes, systems and required documentation; reviews outcomes with wide array of people (i.e., Practice/clinical Directors, Practice/clinical Managers, senior leadership, Coding Manager, hospital case management, managed care contracting and RCC management) and influences adjustments to current facilities, practices.

Assist with maintaining the integrity of the CDM (charge description master) and the software program. Performs other duties as assigned. (40%) + Performs ad hoc consultative research and coordination on current issues of Revenue Cycle regulatory risk including medical necessity denials; identifies a framework of continuous improvement to accomplish programmatic goals; facilitates meetings both internal and external; works collaboratively with system compliance leadership to coordinate and manage RAC and payer audit appeals. Serves as the Revenue Cycle regulatory liaison between the Practice To view full details and how to apply, please login or create a Job Seeker account