Lead Revenue Cycle Advisor (PB/HB Billing & Claims preferred; EPIC exp required) - REMOTE

United States·NashvilleRemotelead

Other

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Quick Summary

Key Responsibilities

Knowledge of the financial process to track patient care from registration and scheduling to the final payment of a balance.

Requirements Summary

Understands all aspects of providing a safe environment and performs routine safety checks to prevent safety hazards from occurring.

Technical Tools

Other

PB Billing and Claims

Provides leadership in evaluating revenue cycle performance operations. Ensures appropriate reimbursement of professional and technical services for multiple areas.

KEY RESPONSIBILITIES

Performs analysis of charges generated from ancillary subsystems to the insurance claim and/or patient statement to verify the accuracy of charges, and of charges that correlate with documented medical/nursing interventions.
Identifies, verifies, and resolves deficiencies or discrepancies in nursing and/or physician documentation that affects billing and notifies the originator of the incorrect documentation to allow for proactive improvements related to charge capture. Assists with quality audits.
Demonstrates and applies the various reimbursement methodologies (DRGs and APCs) to secure optimal reimbursement. Understands the relevance and impact of correct units, modifiers on reimbursement under the various methodologies.
Identifies appropriate charges on the patient bill, utilizing documentation from the medical record.
Collaborates with the clinical department administrators in the development and implementation of educational activities related to charge capture improvement projects.
Coordinates work and communicates and proactively resolves critical charge capture and coding issues to multiple management lines.
Assists with onboarding/training new hires and mentors team members on new concepts, workflow changes, processes where skills need to be enhanced (i.e. Excel functions).
The responsibilities listed above are a general overview of the position and additional duties may be assigned.

What We Offer

~2 min read

Supporting Colleagues: - Develops Self and Others: Invests time, energy, and enthusiasm in developing self/others to help improve performance e and gain knowledge in new areas. - Builds and Maintains Relationships: Maintains regular contact with key colleagues and stakeholders using formal and informal opportunities to expand and strengthen relationships. - Communicates Effectively: Recognizes group interactions and modifies one's own communication style to suit different situations and audiences. Delivering Excellent Service: - Serves Others with Compassion: Seeks to understand current and future needs of relevant stakeholders and customizes services to better address them. - Solves Complex Problems: Approaches problems from different angles; Identifies new possibilities to interpret opportunities and develop concrete solutions. - Offers Meaningful Advice and Support: Provides ongoing support and coaching in a constructive manner to increase employees' effectiveness. Ensuring High Quality: - Performs Excellent Work: Engages regularly in formal and informal dialogue about quality; directly addresses quality issues promptly. - Ensures Continuous Improvement: Applies various learning experiences by looking beyond symptoms to uncover underlying causes of problems and identifies ways to resolve them. - Fulfills Safety and Regulatory Requirements: Understands all aspects of providing a safe environment and performs routine safety checks to prevent safety hazards from occurring. Managing Resources Effectively: - Demonstrates Accountability: Demonstrates a sense of ownership, focusing on and driving critical issues to closure. - Stewards Organizational Resources: Applies understanding of the departmental work to effectively manage resources for a department/area. - Makes Data Driven Decisions: Demonstrates strong understanding of the information or data to identify and elevate opportunities. Fostering Innovation: - Generates New Ideas: Proactively identifies new ideas/opportunities from multiple sources or methods to improve processes beyond conventional approaches. - Applies Technology: Demonstrates an enthusiasm for learning new technologies, tools, and procedures to address short-term challenges. - Adapts to Change: Views difficult situations and/or problems as opportunities for improvement; actively embraces change instead of emphasizing negative elements.

Requirements

~1 min read

Responsibilities:

Certifications:

Work Experience:

Relevant Work Experience

Experience Level:

5 years

Education:

Bachelor's

This role offers the opportunity to make a meaningful impact within Vanderbilt Health, supported by a comprehensive benefits package which may include health, disability, retirement and/or wellness offerings to enhance your well-being and professional growth.

Vanderbilt Health is committed to fostering an environment where everyone has the chance to thrive and is committed to the principles of equal opportunity. EOE/Vets/Disabled.