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

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Sharp · San Diego, CA

Full-timeOn-siteToday

AuditingAWSEpicLeadership

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Responsibilities

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

Requirements

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.

Essential Functions

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.

Work 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.

Might be assigned to support key clinical areas on a need basis.

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).

Assists 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.

Embodies and complies with Sharp Behavioral Standards.

Keeps current with trends, developments in the profession, industry and related fields of expertise.

Knowledge, Skills, and Abilities

Must have an understanding of Revenue Cycle concepts and knowledge of clinical concepts.

Must be prof

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

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