Prisma Health

Compensation

Full Description

Inspire health. Serve with compassion. Be the difference. Job Summary Interacts with departmental revenue owners to monitor charge capture, revenue reconciliation and revenue trending across Prisma Health. Completes focused charge review audits for assigned clinical departments and/or service lines to ensure that charges are generated in accordance with established policies and timeframes. Essential Functions All team members are expected to be knowledgeable and compliant with Prisma Health's values: Inspire health. Serve with compassion. Be the difference. Works assigned Epic charge review and billing work queues to meet our compliant standardized min daytime frame, ensuring appropriate medical documentation exists to support charge capture compliance. Validates assigned principal diagnosis, all secondary diagnoses, principal procedures, and all secondary procedures and CPT/HCPCs codes. Advises departmental revenue owners and their staff on proper usage of charge codes, identifies opportunities for capturing additional revenue in accordance with payer guidelines and develops specifications to modify existing charge capture applications to reduce charge-related claim edits/rejections. Reviews and applies appropriate billing guidelines, state and federal regulations, and third-party billing rules/coverage. Completes internal charge review audits for assigned clinical departments to ensure that charges are generated in accordance with established policies and timeframes. Assist with monthly, quarterly, and yearly Charge capture revenue reconciliation auditing, reporting and education. Partners with vendors for optimization projects to complete data review, auditing, and testing. Performs other duties as assigned. Supervisory/Management Responsibility This is a non-management job that will report to a supervisor, manager, director, or executive. Minimum Requirements Education - High School diploma or equivalent OR post-high school diploma/highest degree earned Experience - Three (3) years of Health care revenue cycle related experience In Lieu Of In lieu of the education and experience requirements noted above, the following combination of education, training and/or experience may be considered an equivalent substitution: Associate degree In lieu of the education and experience requirements noted above, the following combination of education, training and/or experience may be considered an equivalent substitution: Health Science/Business/Coding Certificate and two (2) years healthcare revenue cycle related experience Required Certifications, Registrations, Licenses Job Related Certification in one of the following: RHIT, RHIA, CCS, CPC, CRCA/CRCR, or CBCS preferred. Knowledge, Skills and Abilities Understanding of OPPS, IPPS, ICD10 Coding, HCPCS/CPT Coding, revenue cycle processes. Ability to understand and apply National and Local Coverage Determination to complete assigned work queues and educate facility departments routinely. Work Shift Day (United States of America) Location 1200 Colonial Life Blvd Facility 7001 Corporate Department 70019091 Revenue Integrity Share your talent with us! Our vision is simple: to transform healthcare for the benefits of the communities we serve. The transformation of healthcare requires talented individuals in every role here at Prisma Health. Prisma Health is the largest not-for-profit health organization in South Carolina, serving more than 1.2 million patients annually. Our 32,000 team members are dedicated to supporting the health and well-being of you and your family. Our promise is to: Inspire health. Serve with compassion. Be the difference.