Description:
JOB PURPOSE:
This position provides oversight and support for Revenue Cycle integrity and workflow processes using data analytics. This role assures all established billing, systems, and process requirements have been met in order to ensure timely and optimal reimbursement. Through the analysis of key performance indicator data, this position works to improve Revenue Cycle production and efficiency. Recommends changes that will positively impact the Revenue Cycle and help Piedmont Healthcare (PHC) operate according to industry benchmarks and meet A/R performance goals and productivity.
Qualifications:
MINIMUM EDUCATION REQUIRED:
Bachelors degree in Computer Science, Information Systems, Mathematics, Finance or closely related field.
In lieu of degree, six (6) years of relevant work experience will be accepted in addition to the experience requirement.
MINIMUM EXPERIENCE REQUIRED:
One (1) year of experience exhibiting advanced performance in physician and/or hospital billing revenue cycle required.
(If no degree, a total of seven (7) years of experience required).
MINIMUM LICENSURE/CERTIFICATION REQUIRED BY LAW :
None.
ADDITIONAL QUALIFICATIONS:
Advanced knowledge of third-party insurance, and familiarity with insurance plan types; HMO, PPO, POS, and Indemnity.
Excellent knowledge of Government Programs, including Medicare (CPT, ICD coding/reimbursement, and Medicare Fraud & Abuse regulations), Medicaid and Tricare Programs.
Possesses thorough knowledge of HIPAA regulations.
Possesses advanced knowledge of Revenue Cycle Systems.
Healthcare experience in data analytics, systems performance, and/or accounting.
Experience with root-cause analysis and lean processes.