• Under the supervision and direction of the Chief Revenue Office (CRO), responsibilities include evaluation of current and future business and operational practices and the development and implementation of new systems and/or processes. In addition, review and recommend/implement updates to existing registration and billing processes for new and existing lines of business, develop policies and procedures to ensure desired financial goals are achieved, ensure all regulatory guidelines are satisfied, develop training materials, and validates charge master HCPCS and Revenue codes. Researches & resolves issues related to outpatient claims denials (all Payors) and maintains up to date knowledge of applicable APC/APG regulatory & coding guidelines.

1. 1. Liaison between ancillary departments regarding instruction of regulatory guidelines. Encourages communication between departments to resolve coding and billing issues. Meets with hospital personnel, as needed, to review that regulatory changes are adhered to. Maintains a reasonable understanding of the billing process to ensure that hospital procedures and services are properly ordered. Is familiar with APC coding changes for government agencies and other payers; educates departments on coding and compliance.
   2. Work with Hospital Operations, Compliance, relevant Clinical Teams and Systems to review current process flows and recommend and implement improvements to ensure patient satisfaction and desired financial and regulatory goals are realized.
   3. Develop education materials, policies, and procedures to assist in the implementation and clarification of new regulatory or payer policies. Assists in departmental CDM reviews, validating HCPCS & revenue codes/ Assists in development of superbills. Assists in educational in-services to hospital coding staff. Conducts coding/documentation audits.
   4. Monitors regulatory guidelines, PREPARES DOCUMENTS to add &/or revise cdm as appropriate. Assist in timely implementation of annual HCPCS coding changes. Monitors 3M and PCA OCE/CCI edit reports. Analyzes claim data related to OCE/CCI edits, researches, and resolves edits as appropriate. provides education to coders/ancillary departments related to edits.
   5. Performs research on charges and communicate findings to intra and inter-departmental colleagues, as needed. Works in collaboration with the PFS team to accomplish departmental and strategic goals.

• • Maintains a current knowledge base of federal and state requirements related to HCPCS coding, hospital billing and reimbursement. Maintains standards of professional ethics technical competency.

• Minimum Education:
  • Required:
    • High School diploma. Coding certification required.
  • Preferred:
    • Knowledge of Health Administration as normal acquired through the completion of an Associate’s degree required.
• Minimum Years of Experience
  • Required:
    • 3 years coding experience in an acute care facility is required.
• License, Registry or Certification:
  • Required:
    • Successful completion of certified coding program (ICD-10-CM, CPT-4 HCPCS, APG and APC coding and classification systems).
• Knowledge, Skills and/or Abilities:
  • Required:
    • Good communication skills and previous experience with regulatory guidelines Proficient in Excel, Word. Excellent Writing/Communication required.

Experience in Payer Contracting and rate calculations required. 

Considerable knowledge and experience supporting and developing reporting and analytics for research, process improvement/change management support and specific revenue management function. Ability to develop appropriate methods to collect, analyze and report data 

Experience working with UR systems and Denials required. Proven track record in process improvement. 

Knowledge of Ambulatory Payment Classification (APC), and Outpatient Prospective Payment System (OPPS) reimbursement structures and prebill edits including Outpatient Coding Edits (OCE)/Correct Coding Initiative (CCI) edits and Discharged Note Final Billed (DNFB). 

Exceptional organizational skills and ability to prioritize and manage multiple functions and responsibilities simultaneously.

Experience with post payment audits and with coding, clinical and technical denials is required.

Excellent interpersonal, verbal and written communication and organizational abilities. Accuracy, strong analytical skills, attentiveness to detail and time management skills are required.