Education and Experience-

Education:

• High School Diploma/GED Required.
• Associates or bachelor degree preferred.

Experience:

• Minimum of two years of operational experience in revenue, billing and patient accounting
• Hospital and clinical financial systems, including Billing and Revenue cycles, and Patient Account systems.
• Knowledge of Medicare guidelines for billing hospital and provider based clinic practices, including method II.
• Hospital and clinical EMR systems
• Strong organizational skills.
• Effective communication and meeting facilitation skills.
• Works effectively across the organization with staff in a variety of roles and skill levels.
• Strong analytical skills and the ability to summarize conclusions/recommendations with supporting data.
• Knowledge of all key data elements and data flow of all elements within the Patient Accounting Charge Master and other related files.
• Demonstrated knowledge of claims processing, remittance data and hospital and clinic charge work flows.
• Ability to lead change in the team and department.
• Flexible and able to function effectively with ambiguity.
• Ability to read and interpret regulatory information related to billing of CDM data.
• Effective writing skills for policies, procedures, external and internal communications.

Licenses/Certifications: 

• None required.

Duties and Responsibilities-

Essential Duties:

• Works under the general supervision of the IT Manager.
• Utilizes appropriate analytical tools to extract, compile and manipulate data for purposes of analysis. Presents data in a clear, organized manner. Understands end goal of analysis, as a means to project data needs and requirements.
• Analyze charge data for patterns. Track and trend payer denials. Identify areas for improvement.
• Monitor error reports, daily activity reports, and interim audit information to assure continued accuracy of Charge Master Data.
• Learn, document, and monitor the facility's payer mix, payment methodologies, and payment trends for top hospital services.
• Create, implement and maintain internal policies, procedures, tools, and forms for Charge Master Maintenance.
• Monitor and assist clinical and/or technical departments with new or revised regulatory or coverage guidelines.
• Ensure that Local Coverage Determinations and National Coverage Determinations for Medicare are integrated into daily operations of the billing system and processes.
• Prepare the organization for timely implementation of annual coding updates (CPT, HCPCS); periodic Revenue Code updates, modifier revisions, and regulatory updates related to Charge Master Data.
• Monitor compliance initiatives related to Charge Master Data. Track OIG, FBI, Attorneys General, Fiscal Intermediary/Carrier, and other regulatory agencies' compliance investigatory activities and published findings which may be correlated to Charge Master Data billed.
• Supports the Revenue Cycle and Patient Access operational staff to utilize the integrated EMR and billing system application to its optimal capabilities.
• Acts as team leader and/or project manager for special projects related to Charge Master, including coordinating the work of consultants and external parties.
• Internal ownership of Charge Master, including maintenance, auditing, policies and procedures, and overall quality assurance.
• Ensures timely and accurate implementation of new or revised regulations which affect Charge Master Data.
• Performs as the internal Subject Matter Expert (SME) for current regulations and coverage guidelines for key payers of all current and future healthcare services.
• Monitors and assists clinical and/or technical departments with new or revised regulatory or coverage guidelines.
• Leads the organization to achieve timely implementation of annual code updates (CPT, HCPCS).
• Supports the Revenue Cycle Director and CFO with analysis and special projects as assigned.

• Performs other duties as assigned by Information Technology Manager.

Physical Demands:

• Standard office setting.
• Occasional additional hours may be required to complete projects.

Mission:

• The Revenue Integrity Coordinator will be expected to uphold the mission statement and values of Coquille Valley Hospital. 
• The incumbent is expected and encouraged to continue to learn by experiencing procedures by observation, or interacting with other staff and seminars as available.
• Service: A drive to be of service to others.
• Ethics: A clear understanding of right and wrong which guides your actions.
• Responsibility: A need to assume personal accountability for your work.
• Problem solving: An ability to think things through with incomplete data.
• Empathy: An ability to identify the feelings and perspectives of others.
• Team: A need to build feelings of mutual support and respect.

Coquille Valley Hospital provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability or genetics. In addition to federal law requirements, Coquille Valley Hospital complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.

Coquille Valley Hospital expressly prohibits any form of workplace harassment based on race, color, religion, gender, sexual orientation, gender identity or expression, national origin, age, genetic information, disability, or veteran status. Improper interference with the ability of Coquille Valley Hospital’s employees to perform their job duties may result in discipline up to and including discharge.