Revenue Associate

In order to fill our Mission of serving our community by helping each person achieve optimal health and well-being by providing compassionate, exceptional, and affordable healthcare services, all employees of Genesis HealthCare System must be committed to living the Genesis Mission and Genesis values of Compassion, Excellence, Integrity, Team, and Innovation. All employees must regard themselves as an ‘owner’ of Genesis and keep our patients at the center of everything we do - always. 

Work Shift:

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Department:

Overview of Position:

ESSENTIAL DUTIES

• Maintain and update the System’s CDM in accordance with federal, state, and payer-specific billing regulations. This includes, but is not limited to, hospital and physician entities.

• Monitor and analyze changes to coding standards (HCPCS, CPT, ICD-10), CMS guidelines, and reimbursement methodologies to ensure timely updates.

• Collaborate with Compliance, Legal, IT, Purchasing and Coding departments, as well as department managers, clinical staff, and billing teams to identify and resolve CDM discrepancies or issues affecting revenue, as well as assist with audits and finding resolution.

• Support new service line implementations and ensure appropriate charge codes, pricing, and billing protocols are established.

• Support routine audits of charge capture processes and data and assist in development of corrective action with cross functional teams

• Provide training and education to staff on CDM policies, regulatory updates, and revenue integrity best practices.

• Maintain revenue-related policies in alignment with regulatory and organizational standards; ensure adherence to the established approval process and educate stakeholders on the importance of consistent charging practices.

• Maintain awareness of regulatory changes (e.g., CMS updates, payer rules, billing requirements) and partner with Compliance, Legal, IT, Coding, and Payer relations to implement necessary CDM adjustments.

• Participate in rate setting and annual pricing reviews based on industry benchmarks and hospital cost structures.

• Participate in revenue cycle improvement projects, including charge capture workflow redesign and system implementations.

• Coordinate and oversee the hospital's price transparency compliance efforts, including:

  • Preparing and maintaining the machine-readable file of standard charges (gross charges, payer-specific negotiated charges, de-identified minimum and maximum charges, and discounted cash prices).

  • Ensuring accurate and timely posting of the hospital's shoppable services list and/or consumer-friendly display tools as required.

  • Collaborating with IT, compliance, and legal teams to ensure ongoing visibility and accessibility of pricing data on the hospital website.

  • Partnering with Compliance and Legal to monitor CMS rule changes and enforcement updates related to transparency and implement necessary updates by partnering with Coding, IT, Payer Relations, and other necessary team members.

  • Supporting the development, maintenance, and accuracy of the patient estimate tool by collaborating with IT, Compliance, Legal, and Revenue teams to ensure alignment with current pricing, contractual terms, and regulatory requirements.

• Collaborate with external vendors for payer CDM audits and third-party coding audits, ensuring accurate charge practices, regulatory compliance, and timely resolution of identified issues.

• Assist the Revenue Consultant by executing assigned tasks, supporting strategic initiatives, and ensuring alignment with overall revenue integrity goals.

• Obtain and maintain required certification(s) to ensure foundational knowledge and compliance.

QUALIFICATIONS

1. Associate's degree in Healthcare Administration, Finance, Accounting, HIM, or related field.

a. In lieu of degree, 2+ years of field-related experience required, such as experience in CDM maintenance, revenue integrity, or hospital revenue cycle operations.

2. Obtain required certification(s) within the first year of employment.

3. Strong knowledge of CPT, HCPCS, ICD-10, revenue codes, and UB-04 billing, and CMS price transparency regulations.

4. Familiarity with CMS guidelines, payer rules, and hospital reimbursement models (e.g., OPPS, IPPS).

5. Experience with hospital billing systems (Epic preferred) and charge capture applications.

6. Excellent analytical, problem-solving, and communication skills.

7. Certification in coding (e.g., CCS, CPC) or revenue cycle (e.g., CRCR) preferred but not required.

8. Strong attention to detail, organizational skills, and a proactive problem-solving mindset.

9. Willingness to adapt and learn in a fast-changing regulatory environment.

10. Advanced Excel or data analysis skills.

11. Ability to work independently and manage multiple responsibilities in a smaller team environment.

12. Strong interpersonal communication skills to build relationships across clinical and administrative teams.

13. Excellent verbal and written communication skills; ability to speak clearly and concisely, conveying complex or technical information in a manner that others

can understand, as well as ability to understand and interpret complex information form others.