Job ID: 126327
West Chester, PA, United States
Apr 13, 2022
DescriptionPenn Medicine is dedicated to our tripartite mission of providing the highest level of care to patients, conducting innovative research, and educating future leaders in the field of medicine. Working for this leading academic medical center means collaboration with top clinical, technical and business professionals across all disciplines.
The Revenue Cycle Analyst will work collectively with the Manager of Revenue Integrity, EPIC team, Business Office team, and HIM to track and trend charge initiatives; medical and charge audits from commercial carriers and Medicare (MAC, CERT, RAC) to ensure revenue management, revenue opportunities, and revenue protection. He/she will have direct and indirect interaction with internal and external clients.
o Assists in coordinating charge description master and charge capture initiatives
o Updates, coordinates, and monitors denials management via Cobius system, inclusive, but not limited to, the out-patient RAC program and commercial carrier. This includes recording, reporting and appealing accounts appropriately and according to system policy and procedures.
o Create and run reports that reflect analyses of RAC and commercial denial trends, reporting findings and results facilitating presentation at Revenue Cycle Team meetings.
o Assists with annual CDM reviews from a technical focus and assists as needed in CDM and charge capture education.
o Assist revenue integrity manager and team with communications and information flow.
o Oversight of daily charge reconciliation of assigned departments
o Gathers data and reports for internal and external audits for the following areas:
o Internal audits
o EPIC edits and WQ ownership as assigned– assist with internal reconciliation projects when noted errors have been verified and follow up QA checks to ensure future departmental billing compliance.
o Medical Necessity – assist and coordinates with outreach physician practices and UPHS corporate for updated education and training, along with working with EPIC Revenue Team/UPHS to ensure updated transfer of clinical data
o Assist with charge entry verification and coding reviews to ensure accuracy and compliance.
o Assist revenue Integrity manager in conducting hospital audits providing analytics of outcomes, along with action plans when corrective action is required based on audit findings.
o Work as needed in any areas that may require clinical audit needs as necessary.
o External Audits
o Assist in review of external audit requests for accuracy and reason for audit. Assist in coordination of audit process, including electronic folder preparation with Documentation team.
o Assists in scheduling external audit requests and monitor while audit is in progress at the TCCH campus
o Assist in gathering documentation / response to denials, downgrades or DRG changes, utilizing other resources at TCCH to assist as needed (i.e., Case Management, Coding, etc…).
o Assist patient request regarding services received from TCCH in conjunction with the Business Office. This would include charge/billing concerns, denial support and complaints that are clinical in nature for a patient’s account.
o Proactively apprises the Revenue Cycle Manager of any issues or concerns.
o Participates in activities that help set the tactical and strategic vision for the Revenue Cycle area.
o Works closely with Financial Counselors and self-pay patients to determine cost of care.
o Collaborates with the Corporate Compliance/HIPAA Privacy Officer to assist with incident investigation and follow up.
Professional certification within 12 months of employment inclusive but not limited to AAHAM, HFMA, AAPC
Education or Equivalent Experience:
· Bachelor’s degree or Master’s degree (preferred); equivalent combination of education and experience.
· Knowledge of various hospital information and coding systems, including M/ICD-10-CM, CPT and HCPCS
· 1-2 years’ progressive experience in various hospital functions including coding, reimbursement, compliance, billing and/or other service areas
· Knowledge of content, structure and maintenance of Charge Description Master.
· Ability to work collaboratively with all levels of the organization; and ability to negotiate and manage conflicts and issues
· Knowledge of compliance concerns relative to coding, billing, reimbursement and documentation
We are an Equal Opportunity and Affirmative Action employer. Candidates are considered for employment without regard to race, ethnicity, color, sex, sexual orientation, gender identity, religion, national origin, ancestry, age, disability, marital status, familial status, genetic information, domestic or sexual violence victim status, citizenship status, military status, status as a protected veteran or any other status protected by applicable law.