Rev Cycle Regulatory Coordinator (Roanoke, VA, US, 24011)
Company: Carilion Clinic
Location: Roanoke
Posted on: May 28, 2023
Job Description:
How You'll Help Transform Healthcare: This position is
responsible for reviewing proposed and final regulatory notices and
coordinating with clinical and financial areas any changes needed
related to these regulatory mandates. These mandates, if
incorrectly implemented or not implemented at all, can result in
substantial lost revenue and/or compliance issues for Carilion
Clinic. Identifies trends and assists leadership in development of
process improvement plans and provider education. Manages
statistical tracking, the creation of spreadsheets and serves as a
data resource for other departments. - -
- Stays informed of proposed and finalized regulatory changes.
Works with clinical, financial and/or billing areas, to determine
how the policy/coding changes affect Carilion Clinic from
compliance, financial and/or operational perspectives. -
- Assumes responsibility for conducting a financial and
operational review of the proposed reimbursement changes and
correct coding initiatives. Analyzes the financial impact with
management. Develops appropriate communications and coordinates
with all departments impacted.
- Interprets the rules, guidelines and further researches with
the appropriate third party payor when questions are not readily
answered. Takes responsibility for obtaining and coordinating
communication of substantiated payor guidelines and assists with
implementing changes.
- Assesses the value of adding new services and understands what
payor denials may follow billing processes. -Understands and
explains when/why medical necessity/authorization of services is so
critical to securing reimbursement. -
- Serves as a liaison for payor escalation issues. Identifies
payor trends through monitoring and reporting systematic issues to
management. -Develops action plans when appropriate and in
conjunction with leadership requests.
- Serves as a subject matter expert (SME) on billing operation
applications, and educates/communicates business rules created
around the billing processes as necessary.
- Performs special project activity as requested or suggests and
volunteers to lead process changes. Maintains documentation for
future reference that is inclusive of identified issues and
resolution/action taken. -Analysis, feedback and making
recommendations are common components for this role with an end
goal of creating better processes.
- Promotes Carilion Clinic's Culture of Excellence and quality
service through team work, respectful communication, maintenance of
a professional environment, partnership with those we serve and
anticipation of customer needs. - What We Require: Education:
Associate's degree preferred, with 3 - 5 years of experience in
healthcare related field. Bachelor's degree preferred. Experience:
3 -5 years experience working with healthcare billing, coding,
medical documentation, and/or charge master. Must have an extensive
background in CPT and HCPS coding, third party billing and
reimbursement, APC reimbursement and CMS regulations, to ensure
compliance. Must be proficient with data base programs, Excel,
Word, Access, or other data base software and internet based
systems. Licensure/certification: CPC certification, EPIC
proficiency gained in the billing/charge master arena within first
year. Has, or will obtain within 1 year, Certified Compliance
Technician (CCT) certification or other related healthcare
financial/clinical certifications to establish skill set for the
position. Other Minimum Qualifications: -Demonstrated ability to
work with minimal supervision. Work in a confined area under
pressure to meet deadlines with frequent interruptions. Attention
to detail is imperative, as errors could result in serious
financial loss as well as affect hospital integrity and compliance.
Must be able to read, interpret, apply and distribute to
appropriate personnel, regulations and information obtained from
various state and federal sources. Familiar with Information
Services map through the Charge Master and to the patient's bill.
Excellent communication skills are required to facilitate meetings,
and gather information needed for project related work. Work
independently and use good judgment when making
decisions/recommendations regarding changes to Charge Master.
Excellent time management and organizational skills, with the
ability to function in a high volume work setting with changing
priorities. Reflect professional attitude in a teamwork
environment. Work may require attendance at early morning or
evening meetings. About Carilion This is Carilion Clinic ... An
organization where innovation happens, collaboration is expected
and ideas are valued. A not-for-profit, mission-driven health
system built on progress and partnerships. A courageous team that
is always learning, never discouraged and forever curious.
Headquartered in Roanoke, Va., you will find a robust system of
award winning hospitals, Level 1 and 3 trauma centers, Level 3
NICU, Institute of Orthopedics and Neurosciences, multi-specialty
physician practices, and The Virginia Tech Carilion School of
Medicine and Research Institute. Carilion is where you can make
your own path, make new discoveries and, most importantly, make a
difference. Here, in a place where the air is clean, people are
kind and life is good. Make your tomorrow with us. Requisition
Number: 140565 - Employment Status: Full time - Location: CASB -
Carilion Administrative Services Building - Shift: Day/Evening -
Shift Details: 8-4:30 Recruiter Email: kagonce@carilionclinic.org
For more information, contact the HR Service Center at
1-800-599-2537. Equal Opportunity Employer
Minorities/Females/Protected Veterans/Individuals with
Disabilities/Sexual Orientation/Gender Identity Carilion Clinic is
a drug-free workplace.
Keywords: Carilion Clinic, Roanoke , Rev Cycle Regulatory Coordinator (Roanoke, VA, US, 24011), Other , Roanoke, Virginia
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