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Brigham and Women´s Hospital is more than a healthcare institution - it´s the birthplace of legendary medicine and one of America´s most respected and innovative hospitals.

The BWPO Sr. Revenue Analyst is primarily responsible for independent oversight of third-party payment compliance with negotiated fee schedules and transactional billing compliance with BWPO billing policies and procedures. PRINCIPAL DUTIES AND RESPONSIBILITIES:Third-Party Payment Variance AnalysisUtilizing the PMMC (Preferred Medical Marketing Corporation) contract management and revenue modeling application, the BWPO Sr. Revenue Analyst will: 1.Monitor and evaluate the financial performance of third-party contracts to identify, audit and resolve variances between amounts paid on claims and agreed-upon fee schedules rates.2.Communicate relevant payment trends and variances to business unit billing representatives for follow-up.3.Serve as a training resource for business unit PMMC users.4.Assist Physician Payment Analysis Team (PPAT) to develop comprehensive reimbursement models to assess the financial impact of various reimbursement rates for prospective contracts.Billing Policy ComplianceIn conjunction with the BWPO Payer Relations Manager, the BWPO Sr. Revenue Analyst will verify:1.Transactional billing code utilization in compliance with BWPO Billing Policy.2.Payment denials are reviewed for accuracy, tagged for follow-up and reported to BWPO Senior Management.3.IDX transactions are consistently mapped to PeopleSoft general ledger in accordance with PHS standards for revenue classification. ChargemasterIn conjunction with the PPAT, the BWPO Sr. Revenue Analyst will:1.Participate in the development of assumptions to create the joint BWPO/MGPO joint chargemaster.2.Analyze and distribute the impact of the new fees for all departments.3.Serve as liaison representative between the PPAT and clinical departments to address questions and concerns related the impacts of new fees for all clinical departments.Budget Revenue ModelThe BWPO Sr. Revenue Analyst will have primary responsibility for the BWPO budget revenue model, including:1.Exporting the base model data from POLR reflecting base assumptions for service mix, payer mix, contractual allowance adjustments, bad debt expense and collection rate, by business unit.2.Importing the PPAT assumptions for adjustments to the base model for payer fee schedule changes.3.Incorporate changes in the joint charge master, by business unit.4.Report assumptions and resulting contractual allowance and bad debt rates along with collection rates to each business unit for incorporation in their respective budgets. Other ResponsibilitiesThe BWPO Sr. Revenue Analyst will also be responsible to:1.Model and distribute payer supplemental funds to business units.2. Manage the Private Staff Associations (PSA) funds flow of payer supplemental, pay-for-performance withholds and PSA annual membership fees. 3. Lead analytics for PSA interim and final settlement.4.Research and conduct impact analysis on issues regarding policy changes to Medicare, Medicaid and other payer reimbursement, including updates to the work relative value units (RVUs) and practice expense RVUs, by business unit and the corresponding impact on physician fee schedule and physician incentive compensation plans. 5. Identify patient revenue rate enhancement opportunities and claims processing efficiencies.6. Collaborate on the business unit accounts receivable valuation.7. Perform supervisory duties for analytic support as necessary.8. Perform other ah hoc analysis and reporting support for senior management, as neededEducation: - Minimum of Bachelors degree. Masters degree in related field preferred.Experience: 1.At least three to five years of progressively responsible relevant experience, including demonstrated ability to manage multiple responsibilities in complex environment.2. Comprehensive understanding of healthcare/payer environment. 3. Working knowledge of the hospital and physician reimbursement environment and charge master development.4. Solid experience with clinical and financial systems; and advance knowledge of reimbursement principles including Medicare, Medicaid and Managed Care. SKILLS/ ABILITIES/ COMPETENCIES REQUIRED:1.Proficiency with spreadsheets, database, and presentation software2.Excellent interpersonal skills, including the ability to establish and maintain effective relationships with patients, physicians, management staff and other customers. 3. Strong customer service skills, including the use of appropriate judgment, independent thinking and creativity when resolving customer issues.4. Ability to work independently and as a member of a team. 5. Strong written and verbal communication skills. 6. Strong organizational, analytic and financial skills. 7. Familiarity with IDX billing system for data extraction and analysis.

JOB OVERVIEW: ( Capitation Billing Workflow)This position is responsible for the assessment and analysis of diverse data related to the revenue cycle, maintenance of the core files of the practice management system, synchronization of EmblemHealth and other capitated membership rosters with patient insurance records, and supports all processes in the physician billing revenue cycle.ESSENTIAL FUNCTIONS:1.Reviews revenue cycle patterns by procedure, diagnosis, payment, contractual adjustment, denial, insurance type and insurance groupings. Analyzes and reports variances. 2.Researches and challenges questionable determinations, and identifies work-flow opportunities to prevent or minimize claim rejections and denials at payer level.3.Identifies revenue cycle problems and opportunities, and works to provide effective, practical solutions. 4.Works with cross functional departments to research and resolve issues. 5.Concisely communicates findings and recommendations, both verbally and in writing. 6.Keeps appraised of rules and regulations affecting reimbursement and stays current through appropriate journals and personal contacts of such developments in the industry as may increase the effectiveness of operations. 7.Conforms to all applicable HIPAA and Billing Compliance policies and guidelines. 8.Performs other duties and responsibilities as assigned by the Revenue Cycle Manager SKILLS REQUIRED:1.Must possess a strong understanding of the healthcare revenue cycle. 2.Must demonstrate investigative, analytical, and critical thinking skills.3.Must have knowledge of electronic billing systems for front end and back end functions and show willingness to learn new systems, applications and programs4.Ability to work independently, follow through and handle multiple tasks/special projects simultaneously. 5.Must be able to function in a complex, agile, fast-moving workplace and adapt to a changing environment. 6.Must have superior collaboration and interpersonal communication skills, flexibility and responsiveness. 7.Must have excellent documentation, communication and presentation skills. 8.Must be a motivated individual with a positive and exceptional work ethic with the ability to interact positively and constructively with employees, professional clinical staff and senior management.EXPERIENCE REQUIRED:1.Four years experience in a health care revenue cycle setting with working knowledge of large multi-specialty capitated group practice environment.2.Practical experience of services related to insurance verification and management of patient information. 3.Practical, hands on experience with CMS-1500 electronic claim billing. 4.Knowledge of payer reimbursement / payment policies, medical terminology, and coding (ICD-9, CPT, etc).5.Computer experience (MS Word, Excel, Access, and Outlook). 6.Experience and proficiency with practice management and billing software.EDUCATION REQUIREMENTS:1.Bachelors Degree in health or other related field, or some related college or equivalent advanced knowledge of the health care industry. 2.Advanced certifications preferred (e.g. Registered Health Information Technician, RHIT).3.Equivalent combination of education and experience may be considered.

Certified Coder and Anesthesia biller (will perform both functions) Dundee, Illinois

Need a Certified coder for growing Anesthesia Specific billing and practice management firm. Monday through Friday 8am-4pm. Excellent opportunity and benefits. Immediate opening

This is a regular, full-time, 1.0 FTE, exempt position. This position is eligible for our full suite of employee benefits, including medical, dental and vision coverage, generous 401 (k) plans, commuter programs, and continuing education assistance.The Billing EMPI Data Integrity Analyst provides analysis and expertise to all Swedish Medical Center sites and affiliates as it relates to the overall data integrity of demographic and guarantor information on the Enterprise Master Patient Index (EMPI) and electronic medical record (EMR). Coordinating efforts with organization wide, cross-functional teams including SMC affiliate organizations, the Billing EMPI Data Integrity Analyst assesses reported potential billing compromise events, assists HIM in evaluation of internal and interfaced demographic reports (specifically core demographic analysis related to billing), identifies and communicates training needs, and works with the Registration and PFS Dept Educator to develop policies and procedures that ensure the integrity of the EMPI and EMR. The Billing EMPI Data Integrity Analyst is also responsible for resolving claims affected by confirmed EMPI compromises related to the overlay of patient data or incorrect patient creation or selection, coordinating complete resolution of Epic data integrity (impacted by data originating in SMC affiliate systems or interfaced from Epic to downstream affiliate systems) and reporting such compromises to the Privacy Officer when applicable.Application and Selection Process- When your online application is submitted successfully, you will receive an auto-confirmation message to the e-mail address you have provided in your application. Our selection process is competitive and you will be contacted if your qualifications and our requirements are a match.QUALIFICATIONS:- Associates degree related to business or from an accredited two-year college preferred. - An equivalent 1:1 education / patient access or Master Patient Index quality analysis experience may be substituted for each year of college not completed.- Certified Patient Account Technician (CPAT) credential is preferred. - Will consider candidate without certification but with extensive experience in patient access and / or Master Patient Index quality analysis.- Prior experience in patient access or patient accounts required. Epic experience preferred.- Knowledge of compliance needs related to HIPAA privacy rules required. - Demonstrated ability to be self-directed and learn quickly with strong attention to detail.- Demonstrated analytical skills: ability to analyze complex tasks/systems/problems, determine possible solutions, and coordinate, implement and evaluate most effective solution.- Demonstrated ability to create and prepare reports extracting specific data.- Understanding of the terminology, business processes, and user issues associated with a hospital/clinic practice.- Strong business knowledge of operations that affect the quality and integrity of the Master Patient Index.- Demonstrated understanding of legal and ethical principles and revenue cycle operations that can affect patient safety.- Ability to work collaboratively with team members, operational managers, colleagues, and stakeholders to analyze problems and propose recommended solutions that meet both business and technical needs.- Ability to work with external affiliates to resolve data integrity errors and document resolution appropriately.- Ability to manage and work on multiple projects at the same time.- Demonstrated ability to communicate effectively across a wide range of audiences and manage multiple conflicting priorities.- Excellent interpersonal, verbal, written communication and presentation skills.- Working knowledge of desktop computer systems.- Proficient in MS Office (Work, Excel, PowerPoint, and Outlook). Advanced skills in Excel preferred.- Experience using a variety of computer programs. Misys, EPIC, and CUBS experience preferred but not required.- Some experience in training preferred. Swedish Medical Center has a non-discrimination policy and is an Equal Opportunity Employer.

Director, Revenue Integrity - Brentwood, TN

Job Summary: Creates and maintains standard chargemaster for HMS and Meditech compliant with applicable federal and local regulations. Provides support for hospitals for questions related to outpatient coding and billing issues. General Responsibilities: • Monitors HMS and Meditech CDMs for compliance to CPT coding; regulatory requirements and makes quarterly and annual modifications. • Provides ´Billing Hotline Support´ to hospitals. • Coordinates the activities of the Manager, Revenue Integrity and Clinical Revenue Integrity Manager positions.• Maintains responsibility for Revenue Integrity software (3M APC Oversight; CDM management tool).• Assists Corporate Operations departments (Revenue Cycle, Clinical Operations, Materials Management, Managed Care, IT), Division Leadership and Chief Medical Officer with related duties affecting revenue cycle operations as needed.• Monitors data related to relative effectiveness of internal vs. external charge capture and coding for outpatient services. Qualifications Minimum Qualifications: (Experience, Education and Special Certifications…) • Minimum of 5 years chargemaster management experience required.• 3 years chargemaster consulting experience required.• Extensive knowledge of CPT coding required.• Current working knowledge of OPPS regulations required.• Experience in audit and\or performance improvement helpful.

Job Summary:The position of Biller/Collector is corporate based and will report to the CFO, Physician Services. The Biller/Collector will have responsibility for billing and collecting for facilities within the LifePoint Network of facilities as the need arises. General Responsibilities:- Receives and reviews charge documents from the clinic.- Ensures charge information provided is correct and accurate.- Balances Charge Summary to tickets keyed before updating charges.- Bill primary and secondary insurances using whatever billing system the practice uses to bill their claims.- Contact insurance companies and/or third party payers to determine the reason(s) payment is being delayed and take the necessary steps to resolve the claim and collect the money.- Demonstrate the ability to effectively work with other related systems such as insurance eligibility, filing, and claim statusing systems.- Files corrected claims/adjustments when situations warrant this type of action. - Documents all actions taken on a patients account in the notes section.- Files secondary claims with the appropriate supporting attachments (EOBs) on an as-needed basis.- Releases patient responsible balances to the patients upon notification by the insurance company remits or phone calls made to the insurance companies.- Keeps supervisor apprised of matter regarding charge entry.- Practice and adhere to the Code of Conduct philosophy and Mission and Value Statement.Minimum Qualifications (Experience, Education and Special Certifications) *Minimum of 5 years of recent physician practice billing/collections experience working with a variety of billing/collection system, preferably MISYS and eClinicalWorks systems.*Bachelor´s degree preferred.*Knowledge of medical terminology.*Working knowledge of federal/state regulations regarding billing/collection practices.*Possess good oral and written communication skills.*Must be highly proficient and possess basic working knowledge of Microsoft Word and Excel.*Skill in organization.*Ability to read and understand an EOB.*Must be assertive and relentless in resolving unpaid claims.

The Biller/Collector will have responsibility for billing and collecting for facilities within the LifePoint Network of facilities as the need arises.

Job Summary:The position of Biller/Collector is corporate based and will report to the CFO, Physician Services. The Biller/Collector will have responsibility for billing and collecting for facilities within the LifePoint Network of facilities as the need arises. General Responsibilities:-Receives and reviews charge documents from the clinic.-Ensures charge information provided is correct and accurate.-Balances Charge Summary to tickets keyed before updating charges.-Bill primary and secondary insurances using whatever billing system the practice uses to bill their claims.-Contact insurance companies and/or third party payers to determine the reason(s) payment is being delayed and take the necessary steps to resolve the claim and collect the money.-Demonstrate the ability to effectively work with other related systems such as insurance eligibility, filing, and claim statusing systems.-Files corrected claims/adjustments when situations warrant this type of action. -Documents all actions taken on a patients account in the notes section.-Files secondary claims with the appropriate supporting attachments (EOBs) on an as-needed basis.-Releases patient responsible balances to the patients upon notification by the insurance company remits or phone calls made to the insurance companies.-Keeps supervisor apprised of matter regarding charge entry.-Practice and adhere to the Code of Conduct philosophy and Mission and Value Statement.Minimum Qualifications (Experience, Education and Special Certifications)*Minimum of 5 years of recent physician practice billing/collections experience working with a variety of billing/collection system, preferably MISYS and eClinicalWorks systems.*Bachelor’s degree preferred.*Knowledge of medical terminology.*Working knowledge of federal/state regulations regarding billing/collection practices.*Possess good oral and written communication skills.*Must be highly proficient and possess basic working knowledge of Microsoft Word and Excel.*Skill in organization.*Ability to read and understand an EOB.*Must be assertive and relentless in resolving unpaid claims.

The incumbent serves as the principal billing manager for assigned department(s)/division(s). This position is responsible for the complex and comprehensive management, analysis, organizational development and education of all activities related to professional fee billing and collections for PBG and clients. Essential to this position is a comprehensive understanding of all patient care services, registration and scheduling, billing activity and financial reporting in adherence to University guidelines. Responsible for managing, analyzing and overseeing all the daily operations of the billing units, including but not limited to: registration, batching, coding, charge entry, collections, audits and reporting. Responsible for the development, implementation and quality assurance of all policies and procedures as they relate to PBG operations to provide maximum efficiency and reimbursement. Effective communication of billing issues and trends between PBG and the respective assigned departments as well as the various internal units of PBG. UCI offers excellent benefits including a minimum of 3 weeks vacation per year.

A growing Multispecialty and Rural Health Medical Practice in Southern Illinois (over 40 providers) is seeking a Revenue Cycle Manager.

This is a critical position that reports directly to the Director of Finance for the physician organization. Candidate will be a strategic thinker and be responsible for managing, directing and supervising coding, data entry, billing, insurance follow-up, denial management and cash processing functions. Must possess the ability to work with the clinical and operational management teams to maintain controls over charge entry and point-of-service data integrity and identify improvement opportunities for the revenue cycle. Bachelors degree and Next Gen experience preferred with at least five years of experience managing a Medical Practice business office and a proven track record of successful revenue cycle management.

OmniClaim is a leader and innovator in healthcare cost containment. A privately held, rapidly growing entrepreneurial company, OmniClaim provides a wide range of pre- and post-payment cost containment services, all designed to ensure that its clients are not overpaying on claims. With an impressive, blue-chip client list which includes many of the nation´s largest and most well known insurers, OmniClaims disciplined approach, e-Business strategy and proprietary programs are saving healthcare payors millions of dollars every month. For more information see www.omniclaim.com OmniClaims Data Mining program is designed to ensure that all claims have been paid properly and in accordance with contract terms. Leveraging proprietary software, OmniClaim identifies a wide range of overpayments, including duplicate payments, retro-terminations, misapplied contract terms, violations of payment policies, and COB issues. Their tremendous success in Data Mining presents an opportunity for a dynamic and entrepreneurial leader who, as Director of Data Mining can take the program to new levels. Growing this division creates an additional opportunity for OmniClaim clients to recognize additional savings which would otherwise remain on the table.The right candidate for Director of Data Mining will have a background incorporating claims management for a major hospital, or perhaps cost containment for a health insurer or HMO, with an understanding of data mining and/or overpayment detection. Promising, high caliber candidates with other types of background will be considered. Strong analytical skills are essential; he or she should be comfortable working with complex algorithms and very large data sets. A track record of success in client relationships and project management is important. The Director of Data Mining must be someone with solid managerial skills who can lead, motivate, educate and grow a workforce. He or she is a relationship-builder with strong people skills, and is motivated by providing exceptional service to clients.