Stanford Children's Health - Lucile Packard Children's Hospital
Location: Palo Alto, California
Internal Number: 8476613
1.0 FTE, 8 Hour Day Shift
At Stanford Children's Health, we know world-renowned care begins with world-class caring. That's why we combine advanced technologies and breakthrough discoveries with family-centered care. It's why we provide our caregivers with continuing education and state-of-the-art facilities, like the newly remodeled Lucile Packard Children's Hospital Stanford. And it's why we need caring, committed people on our team - like you. Join us on our mission to heal humanity, one child and family at a time.
This paragraph summarizes the general nature, level and purpose of the job.
The Senior Charge Capture Auditor works closely with clinical departments to ensure compliance with government, payer, and internal charge capture policies; provides education to the clinical departments. This position works with Med Assets software to manage clinical department charge description master (CDM). This position is also responsible for managing Med Assets charge capture audit results, conducting root cause analysis and taking corrective action.
The essential functions listed are typical examples of work performed by positions in this job classification. They are not designed to contain or be interpreted as a comprehensive inventory of all duties, tasks, and responsibilities. Employees may also perform other duties as assigned.
Employees must abide by all Joint Commission Requirements including but not limited to sensitivity to cultural diversity, patient care, patient rights and ethical treatment, safety and security of physical environments, emergency management, teamwork, respect for others, participation in ongoing education and training, communication and adherence to safety and quality programs, sustaining compliance with National Patient Safety Goals, and licensure and health screenings.
Must perform all duties and responsibilities in accordance with the hospital's policies and procedures, including its Service Standards and its Code of Conduct.
Assists Senior Financial Manager with removing coding exceptions from CDM File and analyzing impact.
Attends trainings as required to keep current with Medicare and Medi-Cal coding and compliance guidelines as they pertain to coding, charge items, charge capture, and billing operations and communicates regulatory changes in a timely manner to clinical departments.
Conducts prospective reviews of charge capture practices in the clinical departments and reports findings, provides education to staff responsible for charge capture, monitors ongoing compliance.
Reports potential compliance issues for further analysis and follow-up to the Compliance Department.
Assists Senior Financial Manager with projects to improve revenue compliance, efficiencies in the charge capture process, and CDM charge structures.
Reports financial impact of charge capture practice changes and corrections to current practices. Communicates findings fully with clinical departments.
Reviews EPIC WQs, conducts research needed to resolve the account issues and identifies gross and/or net revenue benefit expected from all account corrections completed.
Reviews Med Assets CCA file to discover and identify system compliance issues and revenue opportunities, conducts root cause analysis to correct identified charge capture issues, and reports the gross and net revenue differential resulting from each discovery and correction completed.
Any combination of education and experience that would likely provide the required knowledge, skills and abilities as well as possession of any required licenses or certifications is qualifying.
Education: Bachelors degree in a work-related discipline/field from an accredited college or university.
Experience: Five (5) years progressively responsible and directly related work experience including one (1) year in the specialty area to which assigned.
License/Certification: None required.
Knowledge, Skills, & Abilities
These are the observable and measurable attributes and skills required to perform successfully the essential functions of the job and are generally demonstrated through qualifying experience, education, or licensure/certification.
Ability to analyze and develop solutions to complex problems.
Ability to apply judgment and make informed decisions.
Ability to communicate complex concepts in simple form to non-finance users to understand the appropriate use and limits of the information provided.
Ability to communicate effective in written and verbal formats including summarizing data, presenting results.
Ability to establish and maintain effective working relationships.
Ability to perform research with various published resources and Internet access to associated information resources.
Ability to quickly learn and become proficient using the Meditech & Cerner systems for charge entry/billing and CDM Software Tool.
Ability to research complex coding and regulatory requirements; the impact of the Charge master on reimbursement, and coding guidelines.
Ability to work effectively both as a team player and leader.
Knowledge of local, state and federal regulatory requirement related to the functional area.
Knowledge of Medicare, third-party requirements, revenue codes assignments, CPT, HCPCS and ICD-9.
DRG and APC classification systems; medical terminology; billing and reimbursement processes.
Knowledge of the relationship of CDM to related areas such as the General Ledger, cost accounting, cost reporting and budget; clinical settings such as Laboratory, Radiology, Physical or Occupational Therapy, Respiratory Therapy, Cardiology, or Oncology.
The Physical Requirements and Working Conditions in which the job is typically performed are available from the Occupational Health Department. Reasonable accommodations will be made to enable individuals with disabilities to perform the essential functions of the job
Equal Opportunity Employer
Lucile Packard Children's Hospital Stanford strongly values diversity and is committed to equal opportunity and non-discrimination in all of its policies and practices, including the area of employment. Accordingly, LPCH does not discriminate against any person on the basis of race, color, sex, sexual orientation or gender identity, religion, age, national or ethnic origin, political beliefs, marital status, medical condition, genetic information, veteran status, or disability, or the perception of any of the above. People of all genders, members of all racial and ethnic groups, people with disabilities, and veterans are encouraged to apply. Qualified applicants with criminal convictions will be considered after an individualized assessment of the conviction and the job requirements, and where applicable, in compliance with the San Francisco Fair Chance Ordinance.