The Business Consulting Lead - Auditor Middle Revenue Cycle position based in Oakland, CA is critical to the overall success of Middle Revenue Cycle.
Job Title / Location: Business Consulting Lead - Auditor - Middle Revenue Cycle (Oakland, CA)�Job Description:�The Business Consulting Lead - Auditor -�Middle Revenue Cycle position based in Oakland, CA is critical to the overall success of Middle Revenue Cycle which is charged with improving revenue year-over-year, while ensuring key processes comply with all applicable regulations. � This position reports to the Project Manager Consultant (Charge Capture and Maintenance). � This individual will interact with both Revenue Cycle and Permanente Medical Group employees. � Specifically, this position performs various audit routines of procedures and services, reviewing medical documentation and charge detail to ensure appropriate revenue capture.�Essential Functions:� - This position is critical in the success and the monitoring of a National aligned CDM, a key component of Revenue Cycle - Reviews various audit reports, identifying areas with charge capture variances.� - Reviews patient charts/accounts to identify medical procedures performed and supplies used in patient care and whether they are being properly reflected in the patient�s charges.� - This position will ensure accuracy of CPT codes, multipliers, revenue codes, etc. to Medicare/Medicaid/other payor compliance standards and mapping from Epic EAP, SUP, and ERX. - Works closely with clinical personnel to identify process issues to ensure that charges are captured appropriately.� - Works closely with peers to track charges through the system and how they are reimbursed based on contracts or government regulations. - Makes observations and recommendations for charge capture in order to maximize reimbursement.� - Identifies lack of documentation and works with clinical staff and physicians to resolve these problems.� - Ensures that physician orders are documented to support procedures performed and supply charges used in providing patient care. - Investigates the appropriateness of procedure/processes to ensure compliance with regulatory agencies.� - Reviews all Medicare, Medicaid, Medi-Cal, and Workers� Comp newsletters/updates and performs frequent review of the CMS, FI, Medi-Cal, and Workers� Comp web-sites to keep abreast of pending changes.� - Works with others to proactively recommend/create plans to adopt and/or implement changes.� - This individual will summarize reviews into clear and concise reports for management review.� - Reports to include recommendations for corrective action, which can include staff training and process improvement; creates and maintains database of reviews performed and reports trends to management at least monthly; serves as a resource to clinical areas to identify lost charge improvement opportunities.� - Possess analytical ability to design methods, collect and review data, formulate appropriate solutions and compile reports.� - This individual prioritizes work based on compliance findings and risk; performs multiple tasks and modifies review approaches based on the organization�s changing situations and needs, and follows through to achieve final resolution.� This individual possesses the ability to effectively communicate, both written and verbal, with all levels of the organization. Performs other duties as assigned. Basic Qualifications:� - 5 - 7 years experience in an acute care setting (nursing care, radiology, respiratory therapy, etc.) or business office for an acute facility is required - Bachelors degree in Finance, Business Administration, Accounting, Nursing or related field is required - Must possess in-depth knowledge and understanding of hospital and medical foundation services, regulatory requirements, CDM management and project management.� - Knowledge and understanding of CPT/HCPCS, revenue coding, and ICD-9 is required.� - Knowledge of MS Office suite, especially experience with database and spreadsheet applications is required - Qualified candidates must have the following skills:: Excellent oral and written communication skills Ability to work with a cross function of people and� influence multiple stake holders internally and externally Project planning & organization skills Problem solving skills Ability to work independently with minimal supervision - The position can be based in Oakland, CA, Pasadena, CA or Portland, OR.� Must be able to work out of one of these three locations.� Preferred Qualifications:� - Advanced degrees or related certifications is preferred - Experience with Epic systems and chargemaster maintenance and billing issues is strongly preferred - Certified Professional Coder (CPC) and/or Certified Professional Coder - Outpatient Hospital (CPC-H) is preferred.� - Certified Coding Associate (CCA), Certified Coding Specialist (CCS), Certified Coding Specialist-Physician-based (CCS-P), Certified in Healthcare Privacy and Security (CHPS), Registered Health Information Administrator (RHIA), and/or Registered Health Information Technician (RHIT) preferred. - Experience supporting a variety of Revenue Cycle processes and programs - Knowledge in application systems, interfaces, reporting processes and data capture - Experience developing project plans and coordinating with multiple stake holders