Essential Functions

• Conduct reviews of charging, coding, and clinical documentation, collaborating with Leadership
• Maintains constant communication with Facility Departments to address identified charging issues. This role ensures the Facility CFO is regularly updated on the progress of charging activities
• Perform charge edit reviews by verifying billing data against appropriate clinical documentation and make appropriate corrections. Based on audit findings, present findings and recommendations to Leadership, as well as facility ancillary department leaders, to enhance documentation accuracy, charging workflows, and overall compliance
• Collaborates with Facility Department Leaders in helping to develop chargemaster and charging practices for new service lines or procedures, following approved standardization guidelines. Monitors charging practices post-implementation to offer targeted guidance and support
• Consistently monitors charging practices across all facilities through charge reviews, remedial training, and education
• Review regulatory communications, applicable CMS transmittals, and Local Coverage Determinations (LCDs), assess their impact on Revenue Integrity procedures, and implement necessary changes
• Maintain up-to-date billing knowledge through webcasts and conference calls, ensuring continuous education
• Possess working knowledge of Medicare guidance, inpatient/outpatient status, and observation requirements
• Participates in charge optimization projects and supports the Corporate Revenue Integrity team on special projects, charge capture reviews, and patient audits as needed
• Provide consistent, accurate, and timely coding of outpatient medical records for appropriate billing and/or data collection.
• Collaborates with the team to maintain and exceed DNFC goals.
• All other duties as assigned

To perform this job, an individual must perform each essential function satisfactorily with or without reasonable accommodation

Education

• Associate Degree or above preferred; or healthcare license/certification required

License/Certification

• Healthcare certification/licensure such as AHIMA or AAPC certified credential, can be accepted in lieu of degree with work experience.

Experience

• Medhost, MediTech, 3M, SSI, FinThrive, Other Coding Tools
• Preferred Minimum 1 year directly related Healthcare experience or coding experience required
• Knowledge of CPT/HCPCS codes or experience in charging or performing charging validation reviews preferred.