Clinical Revenue Compliance Officer

JOB SUMMARY:

Reviews and monitors health care systems and processes relating to billing, reimbursement and collection. Advises billing personnel on policy, procedures and processes for all systems throughout VUMC. Leads the effort to prevent and detect potential regulatory compliance billing problems while partnering with personnel responsible for operating the processes and systems to increase efficiency and effectiveness. Responsible for oversight of and guidance related to Medicare, Medicaid and other governmental programs relevant to the prevention and/or detection of fraud, waste and abuse.


KEY RESPONSIBILITIES:

• Knowledge - Maintain extensive and current knowledge of health care compliance in the areas of coding, billing, reimbursement and revenue cycle process
• Policy Development - Coordinate groups and functions to develop and maintain effective and clear billing policy and procedure applicable throughout VUMC
• Internal Controls - Review and recommends controls and processes implemented by billing personnel and systems to verify appropriate billing, and represent the compliance function in process improvement analysis
• Inquiries - Lead investigations into allegations of billing errors or process improprieties.
• Liaison - Serve as a liaison between external billing auditors and reviewers and VUMC billing and reimbursement functions.
• Collaboration - Facilitate communication between other functions of the Office of Compliance and Corporate Integrity, such as education and auditing & monitoring, and billing personnel to minimize regulatory risk and maximize revenue cycle efficiency
• Management of all compliance aspects of billing for 1500 and UB92, coding (including ICD and CPT), patient demographics, charges, statements and patient inquiries.
• Development of compliance billing office goals and objectives, emphasizing performance improvement. Knowledge management of reimbursement of all payor types in the healthcare and related medical fields
• Employment of situational leadership methodologies to increase efficiency of billing processes
• Development and implementation of mechanisms and controls to ensure appropriate billing and payment cycles and accurate and timely billing, in accordance with established internal and payor requirements
• Direction and partnership on all aspects of medical process including eligibility verification, order entry, charge verification and release, CPT and ICD coding compliance, and claim submission
• Monitoring of charge posting, billing, and collection operations for compliance with established policies, regulations, procedures and standards

CORE ACCOUNTABILITIES:

• Organizational Impact: Executes job responsibilities with the understanding of how output would affect and impact other areas related to own job area/team with occasional guidance.
• Problem Solving/ Complexity of work: Analyzes moderately complex problems using technical experience and judgment.
• Breadth of Knowledge: Has expanded knowledge gained through experience within a professional area.
• Team Interaction: Provides informal guidance and support to team members.

CORE CAPABILITIES:

SUPPORTING COLLEAGUES (P2):

• - Develops Self and Others: Invests time, energy and enthusiasm in developing self/others to help improve performance 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 SERVICES (P2):

• - 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 (P2):

• - 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 (P2):

• - 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 (P2):

• - 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.