Charge Integrity Specialist - PFS Revenue Integrity - Sharp Corporate - Day Shift - Full Time

What You Will Do

• Analyzes, Evaluates, and Reports
  • Reviews and follows-up on daily reports to identify accounts that have potential lost, over, undocumented, duplicate charges.
  • Work with 3rd party vendor identifying missed charges, work workqueue as assigned and rebill accounts accordingly.
  • Reviews and follows-up on daily reports to identify late charges.
  • Researches, identifies, prioritizes, and communicates charge integrity opportunities.
  • Contributes to Revenue Risks and Opportunities management and tracking efforts.
• Demonstrates superb attention to detail and analytical thinking skills.
• Department Support and Teamwork
  • Works with analytics team to generate accurate, timely reports for key stakeholders.
  • Maintains expertise in accurate charge entry and coding requirements.
  • Maintains charge description master (CDM); updating CDM Matrix, maintain all maintenance efforts with clinical department and IT utilizing the Ivanti ticketing system.
  • Contributes to strategic pricing processes to include annual and periodic pricing updates, CPT/HCPC updates and reporting, fee schedule queries, procedure queries to include DEP and BCC lookup.
  • Works collaboratively across disciplines and communicate with various customers while seeking solutions.
  • Prioritizes and attends ad-hoc meetings as needed to provide support in areas of expertise.
• Department System Competency
  • Maintains expertise in and is a go to resource for Epic Revenue Guardian Checks.
  • Maintains expertise in charge source criteria and IT interfaces from upstream systems.
  • Maintains expertise in the patient account system and Charge Description Master (CDM).
  • Affords assistance in deploying technology solutions, developing standard approaches, tools, reports, communication, policies and procedures to be utilized across the system.
• Problem Resolution
  • Reviews and follows-up on issues in assigned Epic Revenue Integrity work-queues.
  • Follows-up with clinical, coding, billing and operational contacts to resolve revenue integrity concerns in a timely manner.
  • Facilitates, documents and presents root-cause analysis for revenue integrity issues, works with management to develop strategies, controls and action plans.
  • Assigns actions, turnaround times to appropriate parties, monitors progress and results, reports out to management.
  • Contributes to analytical, technical and operations problem solution efforts.
  • Works with revenue integrity, finance and clinical leadership to develop, implement charge capture entry, validation, reconciliation and correction processes; developing and implementing protocols, policies and procedures to support charge capture accuracy and timeliness.
  • Ensures relevant controls are implemented in a timely manner.
• Time Management
  • PRACTICES strong organizational and project management skills.
  • MANAGES workflows and tasks by prioritizing, planning, and executing.

Required Qualifications

• 2 years' experience with hospital and ambulatory care charging and coding practices, contractual payment schemes.
• 1 year auditing and/or training experience.
• Driver's License - CA Department of Motor Vehicles - REQUIRED

Preferred Qualifications

• 3 Years Experience in a large hospital setting, medical group, or consulting company.
• Certified Professional Coder (CPC) - AAPC - PREFERRED

Other Qualification Requirements

• Bachelor's degree or relevant experience in excess of four years may substitute for degree - Required.
• Utilizes reliable transportation and possesses adequate personal insurance coverage. Demonstrates clean driving record in accordance with requirements of the employer DMV pull notice program and Sharp HealthCare Driver Guidelines.