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Revenue Cycle Integrity Specialist

Job description



Burr Ridge, IL

Department
2010210 BSD-UCpg-UCpp

About the Unit
The University of Chicago is a private institution encompassing the undergraduate College, six professional schools (Business, Law, Divinity, Public Policy, Medicine and Social Service Administration), four graduate divisions (Biological Sciences, Humanities, Physical Sciences, and Social Sciences) and the University of Chicago Medical Center. The broader University enterprise includes Argonne National Laboratory, Fermilab, and Yerkes Observatory.

Job Information

Job Summary:

Improve compliant and accurate billing and charge capture at the point of service in the University of Chicago Physician's Group (UCPG) revenue cycle to decrease costly back-end work and improve cash flow. Implement and promote consistent revenue integrity practices in regards to compliance in coding, billing, and proper documentation. Optimize reimbursement working in partnership with departments to further develop the revenue stream and documentation processes. Analyzes and assists with correction of billing and coding errors, and provide real time notification to unusual variances. Advises regarding proper revenue cycle processes and workflows. Assists or advises departments regarding resolution of errors that prevent timely, accurate, and compliant claims submittal. Help departments to maximize revenue when CPT (Current Procedural Technology) codes for new technologies and services.

Responsibilities:

  • Review coding accuracy, documentation, application of modifiers, diagnosis codes as appropriate for all Care Network and CAC Ambulatory charge review WQ's
  • Review NCCI (National Correct Coding Initiative) and MUE (Medically Unlikely Edits) requiring addition of payment modifiers to resolve the edit.
  • Identify charging, coding, or clinical documentation issues and work with appropriate leadership and ancillary departments, etc. regarding charging and clinical documentation issues.
  • Provides guidance and/or assistance in the correction and prevention of charges that prevent compliant, timely, and accurate claims.
  • Review clinical documentation against payor specific Medical Necessity guidelines such as LCDs (Local Coverage Determinations) and NCDs (National Coverage Determinations) with the review and coding of conditions and symptoms found in the medical record and via physician query to resolve the edit.
  • Evaluates and analyzes data to ensure all physician billing claims denied inappropriately by payors are identified, appealed, and reversed.
  • Works closely with department leadership and coders to review and obtain Letters of Medical Necessity required to facilitate the denial appeals process.
  • Proactively works with cross-functional teams within UCPG to develop procedures to reduce the number of denials received through reporting and education of denial trends.
  • Categorizes denials based on root cause findings and communicates information to applicable management and associated teams
  • Serves as a resource when necessary for coding, billing, and reimbursement issues.
  • Continuously reviews applicable regulations, updates, and maintains current understanding.
  • Performs special audit requests for denials and assists in the writing of appeal letters.


Competencies:
  • Ability to present information in ono-on-one and group settings
  • Ability to communicate information in a professional and confident manner
  • Demonstrated ability in critical thinking, self-initiative, and self direction
  • Understanding of physiology, medical terminology, and disease process is required
  • Must understand and be able to apply the following regulations: CMS Evaluation and Management Documentation Guidelines, CMS Teaching Physician Guidelines ,CMS Correct Coding Initiative and Third Party Payer Reimbursement Policies and Procedures.
  • Ability to interpret documents such as, but not limited to encounter forms, medical records, physician documentation, lab reports, dictated reports, operating instructions, and policy/procedure manuals.
  • Ability to write correspondence proficiently.
  • Ability to interact with all levels of health care team professionally.
  • Ability to work independently.
  • Ability to meet deadlines and goals.
  • Ability to demonstrate critical thinking by summarizing issues researched and presenting issues and their solutions to management.
  • Ability to use research skills to gain info on complex coding/billing issues.


Additional Requirements

Education, Experience or Certifications:

Education:
  • Two year college degree Health Information Management or equivalent work experience required.
  • Certified Professional Coder (AAPC) or Certified Coding Specialist-Physician based (AHIMA) required.


Experience:
  • Must have strong E/M coding experience.
  • Four to five years demonstrated knowledge of coding.
  • Two years previous experience in medical record chart documentation review.
  • Two years' experience in group education with provider audiences.
  • One year working with Epic PB Resolute/EpicCare.


Technical Knowledge or Skill:
  • Must be proficient in Microsoft Excel, Word, Powerpoint.
  • Strong analytical, problem solving, interpersonal, verbal/written communication, organizational, project management and team development skills are necessary as is knowledge of health information systems and database technology.
  • Must be able to create coding-based curriculum and training materials, deliver effective oral presentations and prepare concise written reports for a variety of audiences and possess basic computer skills.


Required Documents:
  • Resume
  • Cover Letter
  • Reference Contact Information

NOTE: When applying, all required documents MUST be uploaded under the Resume/CV section of the application.

Benefit Eligibility
Yes

Pay Frequency
Monthly

Pay Range
Depends on Qualifications

Scheduled Weekly Hours
40

Union
Non-Union

Job is Exempt?
Yes

Drug Test Required?
No

Does this position require incumbent to operate a vehicle on the job?
No

Health Screen Required?
No

Posting Date
2018-11-09-08:00

Remove from Posting On or Before
2019-05-09-07:00

Posting Statement:

The University of Chicago is an Affirmative Action/Equal Opportunity/Disabled/Veterans Employer and does not discriminate on the basis of race, color, religion, sex, sexual orientation, gender identity, national or ethnic origin, age, status as an individual with a disability, protected veteran status, genetic information, or other protected classes under the law. For additional information please see the University's Notice of Nondiscrimination.

Staff Job seekers in need of a reasonable accommodation to complete the application process should call 773-702-5800 or submit a request via Applicant Inquiry Form.

The University of Chicago's Annual Security & Fire Safety Report (Report) provides information about University offices and programs that provide safety support, crime and fire statistics, emergency response and communications plans, and other policies and information. The Report can be accessed online at: http://securityreport.uchicago.edu. Paper copies of the Report are available, upon request, from the University of Chicago Police Department, 850 E. 61st Street, Chicago, IL 60637.

Full time
JR03367

About Us
The University of Chicago is an urban research university that has driven new ways of thinking since 1890. Our commitment to free and open inquiry draws inspired scholars to our global campuses, where ideas are born that challenge and change the world.

We empower individuals to challenge conventional thinking in pursuit of original ideas. Students in the College develop critical, analytic, and writing skills in our rigorous, interdisciplinary core curriculum. Through graduate programs, students test their ideas with UChicago scholars, and become the next generation of leaders in academia, industry, nonprofits, and government.

To learn more about the university click here http://www.uchicago.edu/

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Job No:
Posted: 11/10/2018
Application Due: 1/9/2019
Work Type:
Salary: