The posting
EQUAL EMPLOYMENT OPPORTUNITY
Race, color, religion or belief, national, social or ethnic origin, sex (including pregnancy), age, physical, mental or sensory disability, HIV Status, sexual orientation, gender identity and/or expression, marital, civil union or domestic partnership status, past or present military service, family medical history or genetic information, family or parental status, or any other status protected by the laws or regulations in the locations where we operate shall not be a factor in employment for this position. Due to the nature of hospital services, it may become necessary to work extended hours.
POSITION SUMMARY
Responsible for leading the charge capture auditing program to ensure charges are complete, accurate, timely and compliant with regulatory and payer requirements. Directs the audit of patient accounts compared to the medical record, whether requested, concurrent or random, and reports results on a monthly basis to the PFS Director. Partners with clinical and ancillary departments, Coding, HIM, Finance and Information Systems to identify root causes of charge errors, close revenue leakage and reduce compliance risk. Oversees the Charge Capture audit team, provides continuous education to departments, and serves as the District's resource for charge capture and charge description master questions.
POSITION SUPERVISORY RESPONSIBILITIES
Reports To: Director of Patient Financial Services
Supervises: Charge Capture Auditors and Nurse Auditors
POSITION REQUIREMENTS
Minimum Education: A degree in Healthcare Administration, Business, Finance, Nursing or a related field required. Equivalent combination of education and experience may be considered.
Minimum Work Experience: Minimum of two years' experience in healthcare revenue cycle, charge capture, coding or billing compliance auditing required.
Required Licenses/Certifications: None required. Active Texas Registered Nurse license, or professional certification such as CPC, CCS, CHRI, CRCR or equivalent, preferred.
Required Skills, Knowledge, and Abilities: Thorough knowledge of hospital charge capture, CPT/HCPCS coding, revenue codes, modifiers, UB-04 billing and outpatient reimbursement methodologies. Working knowledge of CMS regulations, NCCI edits, medical necessity and compliance requirements. Strong analytical skills with the ability to interpret data, identify trends and present findings to leadership. Proficiency with hospital information systems, Microsoft Excel and reporting tools. Ability to interpret and generate written correspondence utilizing proper grammar, spelling and composition skills. Excellent verbal and written communication skills. Ability to lead, coach and develop staff, manage competing priorities and work independently with minimal supervision. Prior experience involving public contact.
Preferred Qualification: Experience with Cerner or a comparable hospital information system and work queue management preferred.
INFECTION CONTROL AND COMPLIANCE
Demonstrates leadership accountability for hand hygiene compliance by actively monitoring performance data and achieving established organizational targets. Success in this area will be measured by quarterly compliance rates, corrective action follow-through, and overall improvement in infection prevention metrics.
QUALITY BEHAVIORAL EXPECTATIONS
Generally and in all job specific duties: Uses critical thinking skills to determine evidence based solutions. Systematically gathers and reviews pertinent information to prevent errors (PDCA -- Plan, Do, Check, Act). Pursues individual or team learning and growth opportunities to continually build skills. Understands and abides by all safety regulations.
SERVICE EXCELLENCE BEHAVIORAL EXPECTATIONS
Generally and in all job specific duties: Maintains patient confidentiality. Rounds regularly with patients, direct reports and/or customers. Uses telephone and elevator etiquette. Acts as an employee ambassador. Committed to know hospital service lines and shows pride in our organization. Uses AIDET when dealing with internal or external customers.
FISCAL RESPONSIBILITY BEHAVIORAL EXPECTATIONS
Generally and in all job specific duties: Takes responsibility for solving problems. Treats company resources responsibly. Performs work functions timely and accurately. Respects our environment; keeps public areas neat and clean and returns supplies to the appropriate areas
PEOPLE BEHAVIORAL EXPECTATIONS
Generally and in all job specific duties: Supports the team through good attendance. Maintains a professional appearance. Creates a positive team environment; flexible and supportive setting an example of cooperation. Uses meaningful communication; provides honest feedback that is valuable and not critical and discourages negative talk and gossip. Respect co-workers.
JOB SPECIFIC FUNCTIONS
- Reinforces HMHD's values, promotes HMHD's Compliance Plan and demonstrates proficiency in understanding of training materials and applicable laws and standards.
- Completes the required corporate integrity and compliance training and education programs and ensures department employees complete their required education in a timely manner according to HMHD policies.
- Assists the Compliance Officer and the Executive Compliance Committee in identifying "high risk" issues within his/her department.
- Complies with all HIPAA standards.
- Directs the charge capture auditing program, including concurrent, retrospective and random audits of patient accounts compared to the medical record to ensure charges are complete, accurate and compliant.
- Monitors and reports on over- and under-charges, late charges, charge lag and charge reconciliation variances by department, service line and charge type.
- Identifies departments with inadequate charge documentation or a high occurrence of late, missed or incorrect charges, and partners with department leaders to implement corrective action plans.
- Ensures charges are supported by clinical documentation and align with CPT/HCPCS coding, revenue codes, modifiers, units, and payer and regulatory requirements.
- Leads root cause analysis when errors and trends are identified and tracks corrective actions through resolution.
- Reviews daily charge rejection and charge edit work queues; ensures timely resolution and escalates recurring issues.
- Prepares a Monthly Audit Results Report summarizing audit volume, error rates, trends, challenges and successes, and presents to the Director.
- Quantifies and reports lost revenue and compliance exposure resulting from charge capture errors; recommends process and system improvements.
- Provides continuous education to ancillary and clinical departments on charge capture, documentation requirements and CDM changes.
- Serves as the charge capture subject matter resource for the District, including clinical departments, Coding, HIM, Finance, IT and Managed Care.
- Collaborates with Information Systems to test, validate and monitor charge-related system builds, interfaces and upgrades.
- Monitors regulatory changes (CMS, OPPS, NCCI, payer policies) and updates audit tools, policies and education accordingly.
- Develops and maintains department policies, procedures, audit tools and workflows.
- Hires, trains, coaches, schedules, evaluates and sets clear performance and productivity expectations.
- Monitors team production, quality and accuracy; conducts inter-rater reliability reviews to ensure audit consistency.
- Responds to account inquiries and escalated charge disputes within 24 hours and resolves issues amicably and in a timely manner.
- Involves the PFS Director when needed.
- Ensures accurate and thorough documentation of comments and actions on each patient account.
- Manages the department resources and workflow in a fiscally responsible manner.
- Promotes and demonstrates excellent customer service at all times with internal and external customers, including patients, physicians, co-workers and all other customers.
- Communicates effectively and expresses ideas clearly, actively listens and follows appropriate channels of communication.
- Adaptable and responsive to change.
- Demonstrates a positive attitude in all assigned tasks and towards others.
- Follows "Call-In" policy by notifying the PFS Director of absence.
- Adheres to hospital and department dress code. Maintains a professional appearance at all times.
- Consistently contributes to the achievement of excellence in healthcare through the quality and caring values of the mission and vision of Hunt Memorial Hospital District.
- Performs special duties and projects as assigned.
