Hours

Shift Start Time:

Shift End Time:

Additional Shift Information:

Weekend Requirements:

On-Call Required:

Hourly Pay Range (Minimum - Midpoint - Maximum):

The stated pay scale reflects the range that Sharp reasonably expects to pay for this position. The actual pay rate and pay grade for this position will be dependent on a variety of factors, including an applicant’s years of experience, unique skills and abilities, education, alignment with similar internal candidates, marketplace factors, other requirements for the position, and employer business practices.

• 3 Years experience in hospital patient billing and/or compliance.
• Experience and knowledge of government regulations related to hospital reimbursement and compliance.

• Experience with Sharp's patient accounting system.

• Bachelor's degree in Business, Healthcare Administration, Finance, or equivalent work experience. - Required

• Government Regulatory Audits
  
  Conducts daily, monthly, quarterly, and yearly audits of various departments and services that have been identified as areas of possible risk by management. Alert appropriate departments when system, personnel or regulation result in adverse outcomes and recommend resolution based on current regulations.
  Identifies new potential risk areas via government payor updates as well as any ad-hoc requests. Tracks and follows through completion on risk areas identified. Performs 60-day post implementation audit of a government regulatory change presented via Billing Compliance Meeting. Creating department reports to show quality scores, Flame reports and identification of error trends and revenue impact.
  Conducts audits (routinely and on as needed basis) to ensure changes were implemented by the department(s) and report findings/recommendations at future meetings.
  Present findings to Revenue Cycle management and Billing Compliance Committee including recommendations.
  Define audit scope and audit methodology in working with Revenue Cycle Management and Billing Compliance Committee.
  Aid in implementation of internal controls to prevent denials and ensure government compliance.
• Department support and teamwork
  Provide support to stakeholders in order to remediate billing/coding issues.
  Researches department charging and coding issues to include condition codes and/or modifiers.
  Provides updates to Charge Master Specialist and AR Manager.
  Assists in other projects as vetted and assigned by direct manager.
  Using analytical skills, identify trends and problem solve.
  Helps design and implement improvements to established or proposed reimbursement process flows in an effort to maximize potential revenue
  Interact with clinical, financial, compliance and management personnel with clear, concise communication, both written and verbal.
  Collaborates with Corporate Compliance on timely updates of applicable CMS publications impacting federal and state level regulated programs. Notify commercial Manager where advantage plans may be impacted after OIG audits and CERT (Comprehensive Error Rate Testing) programs as well as RAC type audits.
  To ensure a compliant government payer claim lifecycle, work closely with charge integrity specialists when charge concerns are identified and coordinate on safety nets. Work closely with pre-service Manager when local and national clinical determinations or payor policy limits impact reimbursement and work to identify safety nets prior to performing services.
  Deliver in-service to PFS staff for newly implemented billing processes for better understanding of regulation and compliance with processes. Involve contracting department, as necessary, and advise commercial team on how to settle payor dispute affected by Government regulations.
• Knowledge Management and Competency
  Subject matter expert for Government Billing regulations.
  Monitors government payor updates and bulletins, reviews and researches all relevant requirements, regulations, and legislations. Compare CMS to Noridian posts, IPPS Pricing updates and Experian release of LCD/NCD updates to validate accuracy and report inaccuracies to appropriate manager.
  Identifies applicability to Sharp HealthCare and its stakeholders.
  Quantifies and records potential impact of identified risks and opportunities.
  Documents and distributes knowledge to all relevant parties. Outreach to management when process drift occurs.
  Maintains risk and opportunities database for government related items.
  Informs management and key stakeholders of upcoming training opportunities and facilitates registration of training as needed.
  Plan, recommend and implement necessary changes in conjunction with management in an organized manner.
  Utilize various applications and websites to identify the most up to date and relevant information (Code correct, Experian, CMS, Noridian, etc.)
• Coordinate Meetings
  Billing Compliance Meetings and Additional Meetings
  Facilitates coordination of communication for Medicare and Medi-Cal policy and regulation updates to stakeholders.
  Compiles, prepares and distributes meeting documents (including usage reports via nThrive CDM database as well as Merlin reporting, SBAR and data analysis), assures summaries are in compliance with all Medicare and Medi-Cal billing updates/regulations, prepared in plain language summary including regulation applicability to Sharp HealthCare.
  Ensures accountability of action items as determined during the meeting.
  Collaborates with the AR Manager in planning and next steps.
  Prepares and delivers updates on billing and regulatory changes in meetings when requested and approved by direct leadership.

• Knowledge of medical terminology, CPT, HCPCS, ICD-10 codes and APC; as well as government payer specific utilization and their modification/use required.
• Knowledge of Federal and State regulations as relates to hospital billing and reimbursement required.
• Knowledge of best practices audit methodologies preferred.
• Expert in Microsoft Office applications required.

Sharp HealthCare is an equal opportunity/affirmative action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender, gender identity, sexual orientation, age, status as a protected veteran, among other things, or status as a qualified individual with disability or any other protected class