Clinical Revenue Assurance Specialist

Department:

10284 Enterprise Revenue Cycle - Revenue Assurance Technical

Status:

Full time

Benefits Eligible:

Yes

Hours Per Week:

40

Schedule Details/Additional Information:

Monday- Friday Remote 630- 3 or 730- 4

Pay Range

$34.90 - $52.35

Major Responsibilities:

• Processes assigned hospital billing work queues in Smart Chart.
• Responsible for trending revenue capture and adherence to standardized charging practices. Provides clear, concise reporting to system leadership.
• Drafts, updates and distributes consistent and accurate hospital billing resources that are understood by targeted audience.
• Provides specialty-focused charge capture education which is tailored for a variety of audiences including billing office, charge entry caregivers, RN, certified therapies and clinical leadership.
• Reviews service line charge capture practices to identify opportunities for enhanced revenue while facilitating consistent charge capture across the system.
• Develops Revenue Assurance departmental charge correction procedures and policies to facilitate consistent hospital billing for the enterprise.
• Partners with IT, MMIS, Chargemaster and pharmacy to maintain and enhance the integrity of charge capture structures within the electronic medical record.
• Participates in departmental quality initiatives.
• Routinely provides summary of efforts to standardize and enhance charge capture for hospital billing across the enterprise to Revenue Assurance leadership.
• Develops, participates and coordinates a variety of enterprise-wide audits, including service line focus audits. Represents Aurora Health Care during external defense audits.

Licensure, Registration, and/or Certification Required:

• Registered Nurse license issued by the state in which the team member practices.

Education Required:

• Bachelor's Degree in Nursing.

Experience Required:

• Typically requires 3 years of experience in inpatient hospital clinical care such as nursing, respiratory therapy, radiologic technologist, physical therapy, occupational therapy.

Knowledge, Skills & Abilities Required:

• Ability to apply clinical knowledge to facilitate comprehensive revenue capture for service lines.
• Advanced knowledge of hospital billing guidelines, payer reimbursement policies and medical necessity criteria.
• Maintains expert knowledge of CPT, ICD-9, ICD-10, HCPCS coding, CCI edits and modifiers.
• Must be knowledgeable in the technical aspects and integrated functionality of clinical and revenue cycle applications.
• Ability to utilize advanced features of Excel, Outlook and other Microsoft products.
• Excellent organization, prioritization, problem solving and reading comprehension skills.
• Excellent critical thinking and analytical skills, with a high attention to detail.
• Ability to successfully lead a team and problem solve complex billing scenarios.
• Ability to mentor other staff and act as a resource on complex audits. Ability to train staff on auditing processes and procedures.
• 10. Ability to take initiative and work collaboratively with others.

Physical Requirements and Working Conditions:

• Must be able to sit 95% of each day.
• Must be able to routinely lift up to 10 lbs. when carrying medical records to place of work.
• May be exposed to extreme weather conditions when traveling between affiliates.
• Operates all equipment necessary to perform the job.
• Exposed to normal office environment, including long period of time viewing computer screens.

This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.

Our Commitment to You:

Advocate Health offers a comprehensive suite of Total Rewards: benefits and well-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more – so you can live fully at and away from work, including:

Compensation

• Base compensation listed within the listed pay range based on factors such as qualifications, skills, relevant experience, and/or training
• Premium pay such as shift, on call, and more based on a teammate's job<