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JOB SUMMARY :

This position is responsible for managing post-payment audits including RAC, third-party denials, chargemaster creation and maintenance, and hold bills assigned as they relate to revenue integrity.

REPORTS TO :

JOB SPECIFIC RESPONSIBILITIES :

Enter charge requests accurately and completely. Maintain charge-related dictionaries

accurately within GE Centricity and other systems. Monitor charge usage and coordinate with

requesting departments to ensure compliance.

Become proficient and efficient in the maintenance and use of all software tools, including GE

Centricity, Microsoft Office Suite, Craneware (CMT, ORT, BA, ISM, PCL, SCL, Audit), Cerner

PowerChart, Surginet, PharmNet, PathNet, RadNet), Lawson, UMC Intranet and Sharepoint, etc.

Assist with automation and upgrades to clinical systems as necessary.

Work all hold bills daily and coordinate any issues to resolution with relevant departments. Keep

the hold bill age at an average of seven days or fewer.

Review push reports and error work lists daily, and coordinate any issues to resolution with

relevant departments.

Stay abreast of communications and updates from payers, Federal Register, etc. Review charge

and compliance related findings and educate relevant departments during regularly scheduled

and impromptu meetings, as needed.

Respond timely to e-mail and phone requests. Train others on proper charging, software tools,

and revenue cycle processes as necessary.

Coordinate and / or assist with all external audit requests and records requests. Coordinate

and / or assist with all internal audit processes. Initiate and complete internal charge audits on a

regular basis.

Coordinate and participate in all year-end charge reviews with clinical departments. Ensure all

required and recommended CPT and charge code changes are complete before January 1st in

GE Centricity and all clinical systems.

Monitor and facilitate denials and appeals processes. Assist with identifying trends and

solutions. Provide education as necessary to prevent further denials.

Keep manager, director, and administrators informed of any issues or problems identified within

the scope of Revenue Integrity.

EDUCATION AND EXPERIENCE :

• College degree in business related field or equivalent experience.
• Medical and insurance terminology.
• Previous experience in patient accounting preferred.

REQUIRED LICENSURES / CERTIFICATIONS / REGISTRATIONS :

None required

SKILLS AND ABILITIES :

• Ability to communicate both verbally and in writing
• Basic accounting and clerical skills
• Customer relations skills
• Knowledge of third party healthcare payers rules and regulations

INTERACTION WITH OTHER DEPARTMENTS AND OTHER RELATIONSHIPS :

• Constant interaction with revenue generating hospital departments is required.
• This position must interact with other departments in a professional and polite manner. This

position must demonstrate that the Patient Financial Services department is committed to

service.

Note : This job description / performance appraisal form does not describe all job responsibilities

that may be assigned to this job. Job responsibilities may change from time to time.

Disclaimer : Nothing in this job description restricts management's rights to assign or reassign

assignments of essential functions. It does not prescribe or restrict the tasks that may be

assigned. Critical features of this job are described under the heading below. They may be

subject to change at any time due to reasonable accommodation or other reason.

PHYSICAL CAPABILITIES :

Work is of medium demand; walking, sitting and standing most of the time while on-duty. Occasional lifting is required. Adequate hand / eye coordination and fine motor skills required for typing.

Talking and hearing is essential in dealing with co-workers and customers.

ENVIRONMENTAL / WORKING CONDITIONS :

Work in a well-lighted, heated and ventilated building. Hours may vary to accommodate the needs of the department.

DIRECT REPORTS :

UMC Health System provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment on the basis of race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

• Request for accommodations in the hire process should be directed to UMC Human Resources. *

Last updated : 2024-05-06