JOB SUMMARY:

This role leads the various Revenue Integrity (RI) initiatives for Wellnow which include monitoring and approving all changes made to Wellnow's charge description master (CDM) and fee schedules and developing CDM strategies that will optimize revenue generation while ensuring compliance with Federal, State and payer regulations and guidelines.

Responsible for managing value capture programs and tasked with root cause analysis and will coordinate with various departments to achieve solutions to revenue capture opportunities. Fosters partnering relationships with the Payer Strategy, IT, Finance, RCM, Compliance, Quality, CDI, Clinical Operations and Coding departments and educates departments with respect to CDM and charge capture.

ESSENTIAL JOB FUNCTIONS:

• Charge Master Management
  • In collaboration with Finance, Revenue Cycle, and Payer Strategy, develop, implement a Charge Master Policy which includes the following key components;
    • Standard calculation for setting charges for each distinct business line (Urgent Care, Occ Med, Work Comp, Allergy, PT, IV, Self-Pay, etc.)
    • Process for requesting charge master changes
    • Process for performing annual charge master reviews by business line
    • Approval authority matrix
  • Develop standard processes and identify resources necessary to update and maintain charge masters in all Revenue Cycle Practice Management Systems accurately and timely.
• Supports and facilitates the annual CDM pricing review in alignment with Finance and Reimbursement policies and guidelines.
• Supports clinical departments related to new revenue initiatives such as being the subject matter expert in the development of new CDM's to support the new clinical service offering.
• Drives communication of CDM changes to impacted clinical departments.
• Supports the maintenance and leads the enhancement of CDM activities via the integrated Revenue Cycle Applications, reviewing and optimizing organizational CDM structures to assure that CDM's accurately reflect services and supplies provided and are consistent with current industry best practices.
• Supports and implements Revenue Integrity initiatives.
• Monitors appropriate revenue cycle performance benchmarks for the organization and partners closely with revenue cycle teams in support of denials management.
• Identifies opportunities for CDM improvement by reviewing existing CDM's and analyzing CDM constructs to enhance effectiveness of patient net revenue realization and minimize revenue leakage across the system.
• Develops tools for the purposes of tracking and identifying potential areas of lost revenue.
• Reviews changes in CPT, Modifiers and other billing codes for accuracy and compliance with all applicable billing guidelines and optimization of reimbursement.
• Collaborates in the development of programs, initiatives, and workflows, which provide alignment with education for internal customers to support regulatory guidelines.
• Ensures staff members are knowledgeable about revenue assurance needs and reimbursement issues identified through audits, reviews and aggregates data analysis.
• Ensure best practice "operations and process flows" are being adhered to and recommend changes as necessary.

MINIMUM JOB QUALIFICATIONS:

• 5 + years of experience in healthcare operations related to revenue cycle management, coding, finance, and/or physician billing.

EDUCATION:

• Bachelor's Degree in Business or Healthcare related field