Under limited direction and according to established policies and procedures coordinates complex corporate revenue cycle studies. Analyzes data, identifies process issues and opportunities to enhance the number of billable services and reduce back end rejections. Coordinates and performs corporate audits to ensure charges are captured and billed appropriately. Determines impact on overall operations, explains effects, develops responses and solutions and communicates with appropriate personnel. Prepares reports that include analysis and interpretation of data and identifies trends which impact the revenue cycle. Assists with review of reimbursement and reserves during month end close. Maintains a high level of expertise to assure compliance with all regulatory and agency requirements, laws and statutes. Review, and approve or deny, adjustments, charity, and refunds related to individual patient accounts. Review, and approve or deny, re-classes posted to individual patient accounts. Clear edits and issues presented on QS, Rapid Response, or other sources as appropriate. Provides support during the month-end close process. Provides continuous communication and feedback to business units for process improvement. Edit resolution to ensure timely and accurate billing (DNSP) Perform other assigned duties as assigned.
1. Associates Degree or equivalent experience. Bachelorï¿½s degree preferred in Business Administration, Healthcare Administration, or related area.
2. Three (3) or more years revenue cycle operations experience preferably in hospital setting. Experience with automated patient accounting systems and electronic billing systems. Managed Care background.
3. Strong working knowledge of third party billing and collection requirements to include Medicare. Medicaid, commercial and Managed Care Payers. Working knowledge of all Business Units, including Patient Access, HIM, Case Management and Finance
4. Knowledge of UB-04 and Explanation of Benefits (EOB) interpretation, along with CPT-4 and ICD-9 Coding and insurance collections and terminology.
1. High level of analytical ability required to compile data in the revenue cycle; review, interpret and analyze financial reports and activities and present findings. Ability to understand relationships within the revenue cycle process, identify potential discrepancies and resolve complex business operational issues.
2. Communication and/or interpersonal skills for contact with internal and external customers/stakeholders to obtain and interpret a variety of information based on knowledge of departmental practices, DMC policies and programs and specific technical and regulatory knowledge. Discretion must be exercised in deciding what and how to communicate. Conflict resolution skills must be exercised where policy issues are concerned both within the functional area and interdepartmentally. Diplomacy, tact and listening skills are required.
3. Strong technical knowledge of financial analysis billing and reimbursement experience.
4. Thorough understanding of financial services computer systems, patient management and accounts receivable and collection procedures.
5. Ability to support multiple projects concurrently and working in a matrixed environment.
6. Strong organizational, customer service, interpersonal, facilitation, and time management skills.
7. Proficient in the use of a personal computer and spreadsheet software including Word, Excel and Powerpoint.
Job: Finance and Accounting
Primary Location: Worcester, Massachusetts
Facility: Saint Vincent Hospital
Job Type: Full-time
Shift Type: Days
Employment practices will not be influenced or affected by an applicantâ��s or employeeâ��s race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship.
Internal Number: 2005034569
About Saint Vincent Hospital
Tenet Healthcare Corporation is a diversified healthcare services company with 115,000 employees united around a common mission: to help people live happier, healthier lives. Through its subsidiaries, partnerships and joint ventures, including United Surgical Partners International, the Company operates general acute care and specialty hospitals, ambulatory surgery centers, urgent care centers and other outpatient facilities. Tenet's Conifer Health Solutions subsidiary provides technology-enabled performance improvement and health management solutions to hospitals, health systems, integrated delivery networks, physician groups, self-insured organizations and health plans.