JOB SUMMARY

Serves as subject matter expert in all billing and revenue cycle activities at TJRH.

JOB REQUIREMENTS

Minimum Education

• High School Diploma or equivalent is required.

Minimum Work Experience

• 10 years of revenue cycle coding/billing/collections management
• In-Depth knowledge of Medicare/Medicaid reporting, billing regulations and compliance
• Working knowledge of federal, state, local, intermediary and private payor specific billing requirements
• Working knowledge of all appropriate billing forms, UB04, 1500 or state specified forms, utilizing the electronic billing systems
• General knowledge of HIM coding, ICD9 & 10
• Complete understanding of CPT’s and HCPC including modifiers
• Complete understanding of SSI edits and billing related reports

Key Skills

• Has advanced knowledge of Microsoft applications including Word, Excel, Outlook and PowerPoint
• Has an advanced understanding of coding, billing and compliance practices
• Has expert knowledge of large revenue recognition systems and practice billing systems
• Possesses expert investigational skills, shows attention to detail, accuracy and ability to manage and prioritize multiple tasks
• Ability to work independently
• Possess initiative, analytical skills, and an ability to operate with a high level of productivity
• Demonstrates advanced communication and presentation skills
• Ability to work and lead in a team environment and develop constructive working relationships with others
• Able to lead others through difficult situations.

FUNCTIONAL DEMANDS

Physical Requirements

Sitting - 16 – 31%

Walking - 16 – 31%

Standing - 16 – 31%

Bending/Squatting - 1-15%

Climbing/Kneeling - 1-15%

Twisting - 1-15%

OSHA Category

Minimal potential for direct exposures.

Visual and Hearing Requirements

Must be able to see with corrective eyewear.

Must be able to hear clearly with assistance.

Other Physical/Environmental Demands

Lifting - 0-50lbs, 50lbs or more with assistance

Carrying - 0-50lbs, 50lbs or more with assistance

Pulling - up to 100lbs

Pushing - up to 100lbs

LEADERSHIP CAPABILITIES

Supports the hospital Mission, Service and Values.

ESSENTIAL FUNCTIONS

• Identifying any revenue cycle reimbursement opportunities for improvement within the hospital operations as well as the provider based and RHC clinics
• Training and educating hospital departments on charge capturing, reconciliation and correction with specific follow up techniques and billing requirements.
• Informing hospital departments on new regulations from insurance carriers to ensure compliance with proper billing guidelines necessary for reimbursement
• Working the unbilled report with necessary departments to reduce unbilled days
• Identifying and resolving any charging issues (improper charges and/or missing charges) as well as charging issues outside work flow process. Escalating the issues to management when necessary
• Ensuring appropriate prior treatment authorizations are completed and/or notifies appropriate person of missing or incomplete billing requirements and follows up in a timely manner
• Researching for proper charging for billing requirement to ensure submission of clean and compliant claims to governmental and private payers
• Identifying and resolving core issues causing delayed payments, under payments, claim denials and zero pays
• Periodically auditing bills and comparing to medical records and clinical documentations to support claims or appeals as necessary
• Working on financial or compliance audits as necessary
• Working with Business Office Leadership to improve the AR, Cash Flow and other key indicators.

ORGANIZATIONAL EXPECTATIONS

T.J Pledge

I Will Show Compassion

• see all patients, family members, coworkers, physicians, and anyone else at T.J. as my customer.
• recognize that each and every interaction I have at T.J. Regional Health matters
• show kindness and compassion towards my customers at all times
• be sensitive to the personal and private needs of every customer

I Will Cooperate With Others

• maintain zero tolerance for abusive behavior
• listen and be willing to accept fault when I make a mistake
• never underestimate the power of an apology
• refrain from blame and judgment
• bring a sense of calm to stressful situations

I Will Collaborate With Others

• value myself and every coworker as an equal part of one GREAT team working together
• treat others in a way that I would like to be treated
• participate only in conversations that are courteous, respectful, and reflect positively on my teammates and T.J. Regional Health
• foster a calm and pleasant atmosphere, and refrain from gossip, rumors, and insults
• speak honestly, seek truth, and act with integrity towards my teammates
• value the uniqueness and expertise that each team member contributes to the whole
• meet the need of the moment, regardless of whether or not it is considered part of my job

I Will Communicate

-smile - at everyone

• always introduce myself, my role, and my purpose use body language, eye contact, and tone of voice that shows respect in every interaction
• follow the 10/5 rule: always acknowledging people at 10 feet away with a smile and always greeting people at 5 feet away
• escort any customer in need (visitors, patients) to their destination

I Will Adapt To Change

• be a part of the solution when I am presented with a challenge
• embrace change and set the example for those around me
• accept openly when there are changes that T.J. Regional and/or I have no control over
• manage the expectations of others by explaining duration and next steps as often as needed

I Will Be A Champion

• serve with passion
• view myself as an owner of T.J. Regional Health and act accordingly
• take responsibility for the physical appearance of T.J. Regional Health, including my work area
• go out of my way to daily thank and compliment my customers and coworkers
• dare to make a difference and be exceptional
• constantly try to improve myself and T.J. Regional Health
• speak positively about T.J. Regional, while at work and in public places outside of work