Requisition #: 212044
Title: Supervisor, Revenue Integrity
Department: Revenue Integrity
Posting Date: January 14, 2021
Location: UMass Memorial Health Care – 306 Belmont St, Worcester, MA
Serves as a Hospital Billing Revenue Integrity and regulatory gatekeeper to ensure compliance with coding and billing guidelines. Reviews all assigned edits and denials within prescribed timeframe and routes to appropriate owner for resolution. Provides regulatory coding and billing support to Clinical Charge Capture Specialists (CCCS) to address Charge Description Master (CDM), coding, charge capture and billing questions and serves as an educational resource for assigned CCCS staff.
- Bachelor’s degree in business administration, accounting, management, healthcare administration, nursing or related field (preferred) or three – five (3-5) years of work experience related to hospital billing and coding.
- Coding Certification (e.g. Certified Outpatient or Professional Coder, American Academy of Professional Coders).
- Knowledge of industry standard practices, including ICD, CPT / HCPCS codes and third-party reimbursement policies.
- Knowledge of coding and billing requirements based on third party publications, including Blue Shield, Medicare, Medicaid, commercial insurers and HMOs / PPOs.
- Strong interpersonal and communication skills.
- Ability to speak and present in front of groups required.
- Detail oriented, strong analytical skills with the ability to multi task and prioritize.
- A working knowledge of Microsoft Office applications, ability to develop reports and create presentations.
- Directs and supervises assigned personnel in their day-to-day tasks including scheduling, orientation and training for new staff.
- Identifies opportunities for edit creation to decrease payer denials.
- Works closely with HB Revenue Integrity Business Analysts to trend edits and denials from the root cause.
- Collaborates with clinical / ancillary departments to provide feedback on edit and denial root causes and corrective action development.
- Ensures system wide compliance with federal, state and local regulations with regard to charge codes and related information in the CDM.
- Reviews and resolves all assigned charge edits and denials within prescribed timeframe.
- Provides support and guidance to CCCS staff to resolve outstanding edits and denials.
- Serves as an educational resource for assigned CCCS staff.
- Monitors daily edit reports and alerts clinical departments of delinquencies.
- Determines edits and denials that can be resolved by the CCCS staff and oversees the transition of the work from other areas within the Hospital Revenue Integrity department.
- Takes part in identifying and development of job aids for the CCCS staff to utilize once edits and denials are transitioned to them.
- Monitors write offs based on edits and denials to ensure all aspects of charge appeal or resubmission have been exhausted.
- Utilizes subject matter knowledge to support proper interpretation and analysis of performance report(s).
- Monitors all customized charge related edits for resolution.
- Provides accurate feedback and documentation to support educational needs.
- Communicates outcomes to corresponding UMass Memorial Health Center (UMMHC) system executive clinical and operational leadership to prioritize areas of focus and support ongoing performance, as required.
- Serves as a liaison between the clinical and operational leadership, leading multiple levels of ancillary staff in varying locations system wide.
- Collaborates with Hospital Billing Revenue Integrity audit / education team to develop training program and materials in accordance with clinical service line structure and IT application.
- Participates in education sessions by providing support resulting in optimal feedback outcomes to the clinicians.
- Researches third party coding and billing guidelines and ensures timely and accurate compliance with federal, state, local payer requirements as well as UMass Memorial Medical Group contracts specific to charging, coding, bundling and unbundling, modifier reporting requirements.
- Collaborates with Hospital Billing Team for denial remediation.
- Collaborates with Clinical Denial Management and CDM team to support audit activity based on payer denials.
- Provides audit feedback to key clinical and revenue cycle stakeholders for continuous improvement.
- Supports Hospital Revenue Integrity Director in leading targeted revenue improvement opportunities and assists with analyzing the financial impact as related to assigned clinical departments and revenue cycle areas.
- Complies with established departmental policies, procedures, and objectives.
- Attends variety of meetings, conferences, seminars as required or directed.
- Demonstrates use of quality improvement in daily operations.
- Complies with all health and safety regulations and requirements.
- Performs other similar and related duties as required or directed.
- Works independently while contributing effectively to the accomplishment of team objectives and goals.
Standard Supervisor Level Responsibilities:
- Supervises assigned personnel including performance evaluations, scheduling, orientation, and training. Makes recommendations on employee hires, transfers, promotions, salary changes, discipline, terminations, and similar actions. Resolves grievances and other personnel problems within position responsibilities.
- Coordinates the assignment of tasks and helps resolve technical and operational problems. Evaluates the impact of solutions to ensure goals are achieved.
- Provides effective direction, guidance, and leadership over the staff for effective teamwork and motivation and fosters the effective integration of efforts with system-wide initiatives.
- Encourages and supports diverse views and approaches, demonstrates Standards of Respect, and contributes to creating and maintaining an environment of professionalism, respect, tolerance, civility and acceptance toward all employees, patients and visitors.
- Integrates diversity into departmental objectives, such as hiring, promotions, training, vendor selections, etc.
- Participates in performance improvement initiatives and demonstrates the use of quality improvement in daily operations.
- Ensures compliance with regulatory agencies such as Joint Commission, DPH, etc. Develops and maintains procedures necessary to meet regulatory requirements.
- Ensures that department complies with hospital established policies, quality assurance programs, safety, and infection control policies and procedures.
- Ensures adequate equipment and supplies for department.
- Develops and maintains established departmental policies, procedures, and objectives.
- Ensures compliance to all health and safety regulations and requirements.
- Performs similar or related duties as required or directed.
All responsibilities are essential job functions.
We’re striving to make respect a part of everything we do at UMass Memorial – for our patients and for each other. We’re expecting that our new caregivers practice our six Standards of Respect: Acknowledge, Listen, Communicate, Be Responsive, Be a Team Player, and Be Kind, to help us make respect a part of how we take care of business everyday.