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Sharp HealthCare · 1 month ago

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

San Diego, CA

Full-time

Onsite

Entry, Mid Level

$49.70/hr - $71.82/hr

2+ years exp

Sharp HealthCare is a healthcare organization seeking a Charge Integrity Specialist to serve as the operational subject matter expert on charge integrity solutions. The role involves supporting charge description master maintenance, coordinating revenue enhancement opportunities, and ensuring accurate charge entry and coding requirements in alignment with the organization's mission.

Health CareNon Profit

Responsibilities

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

Qualification

Charge integrity solutionsHospital coding practicesAuditing experienceCertified Professional CoderRevenue Cycle conceptsMicrosoft Office proficiencyAnalytical thinkingAttention to detailProject management skillsTeam collaboration

Required

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

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

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

Must be proficient with Microsoft Office Applications to include Teams application as main source of collaboration within department