Category Archives: Jobs

Clinical Coding Coordinator

JOB ID: EB-1535406314
Location: Florida

The Clinical Coding Coordinator will perform internal quality assessment reviews on HIM Inpatient and Outpatient Coders to ensure compliance with national coding guidelines and coding policies for complete, accurate, and consistent coding that result in appropriate reimbursement and data integrity. Review records with the coding team to improve the accuracy, integrity, and quality of patient data, to ensure minimal variation in coding practices and improve the quality of physician documentation within the body of the medical record to support code assignments. Coordinate with the coding supervisors and manager to also provide coder specific education and global coding education based on review findings and trends.

Requirements:

  • RHIT, RHIA or CCS Certification required
  • 5+ years coding experience required

APPLY NOW

 Please send your resume in Word or PDF format to: [email protected]

Copy and Paste the following job title and EB code and place it in the subject line of your email so we can identify the job: Clinical Coding Coordinator (EB-1535406314)

If you have any questions or would like additional information please call (888) 646-1330

062918

Posted By: nearterm-admin

Senior Revenue Integrity Analyst

JOB ID: EB-1465241181
Location: California

Are you a Senior Revenue Integrity Specialist? Are you interested in working in a fast paced, multi-entity, academic teaching organization? Then keep reading! Our client is looking for a hands-on, energetic individual for their Senior Revenue Integrity Analyst position. They have defined their Revenue Integrity function to include revenue capture, compliance, price modeling, cost analysis and pricing strategy. The successful candidate will have experience maintaining, analyzing, standardizing and modeling revenue charges; providing reference material and charge compliance education; assisting financial planning and analysis; clearing revenue integrity related work queues in EPIC and identifying trends related to the root cause of edits. Review, analyze, verify accuracy of CDM, fee schedules, and associated master files. Perform, document, and communicate annual/interim price adjustments. Assist the Director of Revenue Integrity with driving charge capture and revenue reconciliation to ensure all charges are being captured. Ensure CDM updates occur on a regular basis, synchronize financial systems with CDM maintenance vendor tool monthly, scripts work smoothly, new users are trained, and regular communication with CDM maintenance vendor support with issues and suggestions to continue to enhance the product. Engaging stakeholders throughout the organization; provide guidance, communication and education on correct charge capture, coding and billing processes to clinical department; will oversee the maintenance of the CDM and the payer audit response department; will serve as a key leader in future work flow design and management under EPIC financials; and will approve and /or develop key language for billing agreements between the hospital and physician entities owned by our client. Strong communication and strategic planning skills are key.

Requirements:

  • Bachelor’s degree in Accounting, Finance from an accredited college or university or equivalent experience required.
  • American Association of Healthcare Administrative Management (AAHAM) Certified Revenue Integrity Professional (CRIP) within one year of hire date.
  • Outpatient Coding Certification.
  • Registered Nurse.
  • 5+ years Hospital/Health Care Coding experience
  • Knowledge of various spreadsheet applications.
  • Knowledge of billing requirements related to charges and associated claim forms.
  • Knowledge of cost accounting concepts, principles, and computer applications.

APPLY NOW If you are a highly motivated, proven manager with the experience, skills and knowledge to make a difference for our client……………………

Please send your resume in Word or PDF format to: [email protected]. Copy and Paste the following job title and EB code and place it in the subject line of your email so we can identify the job: Senior Revenue Integrity Analyst (EB-1465241181)

If you have any questions or would like additional information please call (888) 646-1330

062918

Posted By: nearterm-admin

Manager of Denials & Utilization Review

JOB ID: EB-4971828700
Location: CALIFORNIA

Are you well versed in denials and utilization? An expert in healthcare revenue with excellent managerial and interpersonal skills? If so, our client would love an opportunity to talk with you about their Manager of Denials & Utilization Review opening. The successful candidate will have experience in the management of denials and appeals between system and outside payers. Be responsible for concurrent utilization review and management of patients within the system. Serve as a liaison and point of contact for all denial and appeal inquiries. Focus areas include denials and appeals, compilation of management reports such as: 1) denials in progress, 2) wins/partial wins/losses, 3) cases where system has elected not to appeal based on chart documentation/support, and 4) identified cases pending review. Concurrent with these activities, the manager will identify and report on the categorization of denials, suspected or emerging trends related to payer denials and/or slow payment, and lead action planning for correction and process changes to eliminate avoidable denials.

Requirements:

  • Bachelor’s degree in Business, Accounting, Finance, Nursing or related field from an accredited college or university
    Current nursing license in good standing.
  • If not an active California nursing license, would need to become certified in California upon hire. Certification in case management preferred.
  • Must be able to demonstrate an understanding of InterQual and Milliman guidelines, community standards relevant to inpatient acute care, and payer denial and appeal processes.
  • Must be able to exercise independent discretion and judgment, and act at all times with the highest degree of professionalism and objectivity.
  • Must be computer literate and able to manage Outlook, Word and Excel programs, prepare charts and graphs, and analyze data to identify trends and opportunities for process improvement.
  • Knowledge of various spreadsheet applications, including Microsoft Word. Knowledge of billing requirements related to charges.
  • 2+ direct patient care experience as an RN in an acute care setting.
  • 3+ years of experience working with denials and appeals, utilization review, and case management in an acute care setting.
  • 2+ years supervisory experience.

APPLY NOW

Please send your resume in Word or PDF format to: [email protected]
Copy and Paste the following job title and EB code and place it in the subject line of your email so we can identify the job: Manager of Denials & Utilization Review (EB-4971828700)

If you have any questions or would like additional information please call (888) 646-1330

180629

Posted By: nearterm-admin

“I promoted the best AR Specialist in our organization to a management position – oops!”

Here is a story from one of our clients that you may find interesting;

Things were in good shape in our revenue cycle management process. Metrics and the Dashboard indicated that we were current in billing, follow-up, and cash application. Denials were under control. Days were low. Patient complaints were handled promptly. You get the picture.

I attributed a lot of this sustained success to one of our team members (let’s call her “Julie”) who had been with us a long time and had worked effectively in patient access, billing and denial management. Julie was very knowledgeable about our system, got along well with coworkers and had good social skills. A model employee!

Passing the Patient Accounts Torch

When our Patient Accounts Manager retired, we were tasked to fill the vacancy. The Patient Accounts Manager had done a great job so this was not a “turnaround.” He was a natural leader, knew the technical side of the business and understood the multidisciplinary processes and relationships that are so important in RCM.

We thought Julie deserved a shot at this position and that she could apply her technical knowledge in a management capacity. Our management team was unanimous that we should offer her the opportunity, so we did not initiate a search nor did we engage an interim manager. It was understood that the management team would all mentor her in the transition. We offered Julie the position and she was flattered and delighted to accept so we introduced the change.

After a short few months, performance began to slip. Morale declined. Julie was stressed and unhappy. Team members and colleagues came to grips that they had made a mistake promoting Julie to a management position.

The result was that they

  1. lost Julie, one of their best technicians
  2. burdened the organization with poor management
  3. are now in the costly process of recovering.

5 Lessons for Filling Vacancies

Here are six learnings that can be applied when vacancies occur:

  • Consider the entire universe of talent that is available to fill the vacancy instead of limiting your search to internal candidates. It is not about who is deserving or qualified – it’s about who is best.
  • Give yourself time to make informed decisions that will serve you well in the long term. It is often advisable to bring in interim management services to get you through the vacancy transition until permanent leadership can be identified and hired or promoted.
  • Recognize that being a great technician is an entirely different skillset than being a great manager but no less important. Other countries have embraced this and redefined culture so that technicians can advance their “status” and compensation on a scale equal to managers.
  • Succession planning is not just for the C-Suite. Every position in the organization is important or you probably would not have it there in the first place. Design a plan that addresses what you would do in the event of vacancy for each position. It is not necessary to name a successor, but it is important to have a plan. For example, would you promote from within, reorganize, engage interim help, rely on internal recruiting or go outside for talent acquisition? The answer may vary from one position to the next.
  • If you have your eye on a candidate for internal promotion, assess training and development needs well ahead of offering the promotion. Let the person know what development goals they would have to accomplish in order to advance and invest in them.
  • If you are in a rural community or a location where the talent pool is limited, you have a “make or buy” decision when filling a vacancy. If you decide to “make”, it is imperative that training resources are prepared and that you have the time to allow an inexperienced person to get up to speed. You must also be prepared to quickly assess the capability of the new hire to absorb the training and be effective in your organization. Hiring inexperienced staff is expensive and can be a distraction to the rest of the team. However if you decide to “buy”, you should expect highly trained candidates with strong experience. The training curve is minimized and you have the opportunity to vet a range of talent. Often, you can introduce interim management resources that strengthen your human capital “gene pool” and elevate overall performance that is sustainable.

Perhaps these ideas will help you avoid losing your best technician while making an ill-advised promotion.

Posted By: nearterm-admin
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