Supv Rev Integrity-Ops
Supv Rev Integrity-Ops
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Job Description
Overview
Supervisor Revenue IntegrityOperations
Full time 80 Hours Per Pay Period Day Shift
Covenant Health Overview:
Covenant Health is East Tennessees topperforming healthcare network with 10hospitals and over 85outpatient and specialtyservicesandCovenant Medical Group our areas fastestgrowing physician practice division. Headquartered in Knoxville Covenant Health is a communityowned notforprofit healthcare system and the areas largest employer with over 11000 employees.
Covenant Health is the only healthcare system in East Tennessee to be named six times by Forbes as a Best Employer.
Position Summary:
Responsible for supervision of clinical audit and appeals processes conducted by Revenue Integrity Department Auditors and Appeal Coordinators. Oversees audit and denials management workflow including quality and reporting. Provides departmental and auditor education regarding payer policies coding and charging practices. Maintains organizational and professional ethical standards and works with Covenant leaders to coach mentor and train department staff. Works independently under limited supervision with significant latitude for initiative and independent judgment. Works with Covenant Health entities to lead and conduct revenue cycle and compliance audit projects as they relate to charging coding documentation and billing. Provides consulting services to the organizations management and staff and may coordinate requested investigations. Coordinates annual audit plan. Maintains electronic audit tool. Oversees use and training of the denials management system.
Recruiter: Kathleen Rice
Responsibilities
- Identifies and evaluates company risk areas and provides auditing services related to documentation and reimbursement.
- Reviews ADR log denial reports and Payer websites to identify potential risks and trend data.
- Reviews and studies all information published by MAC CMS and the OIG via the Federal Register fraud alerts OIG advisory opinions and other publications relative to coding billing and reimbursement compliance in order to ensure compliance.
- Reviews information from third party payers relative to claims charging coding and billing in order to ensure compliance.
- Performs research and analysis of charges CPT coding modifiers and billing processes to ensure compliance with Medicare Medicaid guidelines and other insurance payers and department policy compliance.
- Explains charges and charging procedures to third party insurance companies for defense audits as applicable.
- Coordinates with appropriate parties the complete/partial payment or repayment of the claims as described in the Audit Policy as findings are identified that are either overpayments or underpayments.
- Communicates or assists in communicating the results of audit and consulting projects via written reports and oral presentations to management.
- Documents all audit activities in a designated location; reports statistics and identified problems monthly or more urgently if deemed necessary.
- Monitors audits performed at the department level in order to ensure that data is appropriate being maintained and being disseminated to leadership as indicated.
- Assists with payer denials when necessary.
- Performs data analysis of analytics in order to guide process improvement efforts provide realtime education of our staff and physicians and facilitate best practices.
- Oversees use and training of the audit tool and denials management system including policy and procedure development.
- Works with the department manager to assist with implementation of solutions to maintain a proper compliance stance.
- Works with Covenant Health entities to improve revenue cycle process and adhere to organizational compliance standards as they relate to charging coding documentation and billing compliance.
- Works with the Chief Compliance Office relative to coding billing and reimbursement compliance issues.
- Works with the Chief Compliance Officer in the development and ongoing activities involved in the baseline and periodic compliance audits and compliance programs as deemed appropriate by manager.
- Works with contract management personnel in the review of contracts and other reimbursement or payment arrangements in relation to charging coding and billing compliance.
- Works closely with Financial Analysts to identify process improvement activities and audit opportunities as well as interpret payer appeals processes.
- Works closely with coworkers to identify process improvement activities and to reduce denials.
- Advises educates and acts as clinical/billing liaison between CFOs department managers and billing staff to maximize reimbursement within compliance guidelines for Medicare Medicaid and other insurance payers as deemed appropriate by manager in relation to denials audit findings and process improvement initiatives.
- Coordinates and facilitates problem resolution sessions where multiple departments and/or service areas are involved as deemed appropriate by manager.
- Maintains lines of communications with facilities in an ongoing effort to improve the overall quality of customer service.
- Motivates coworkers and promotes a team effort in accomplishing goals and deadlines with accuracy dependability and professionalism.
- Coordinates with staff to ensure necessary materials equipment and/or supplies are maintained utilizing all avenues of resource management in ordering supplies for departmental needs.
- Follows policies procedures and safety standards. Completes required education assignments annually. Works toward achieving goals and objectives and participates in quality improvement initiatives as requested.
- Performs other duties as assigned.
Qualifications
Minimum Education:
Bachelors degree or Associates degree preferred. In absence of degree will consider combination of education and five (5) or more years of related experience in revenue integrity revenue cycle or corporate compliance.
Minimum Experience:
Three (3) to five (5) years of experience in health care related field.
Licensure Requirement:
None
Employment Type
Full-Time
