Charge Reconciliation & Audit Specialist - Remote - 123694
Job Description
#123694 Charge Reconciliation & Audit Specialist - Remote
Extended Review Date: Mon 7/24/2023UC San Diego values equity, diversity, and inclusion. If you are interested in being part of our team, possess the needed licensure and certifications, and feel that you have most of the qualifications and/or transferable skills for a job opening, we strongly encourage you to apply.
For the safety and well-being of the entire university community, the University of California requires, with few exceptions, that all students, faculty and staff be vaccinated against the COVID-19 virus and influenza before they will be allowed on campus or in a facility or office. For more information visit: Flu Vaccine Mandate / COVID Vaccine Policy
UCSD Layoff from Career Appointment: Apply by 06/21/23 for consideration with preference for rehire. All layoff applicants should contact their Employment Advisor.
Special Selection Applicants: Apply by 06/30/23. Eligible Special Selection clients should contact their Disability Counselor for assistance.
Candidates hired into this position may have the ability to work remotely.
This position will remain open until filled.
DESCRIPTION
UC San Diego Health's Revenue Cycle department supports the organization's mission to deliver outstanding patient care and to create a healthier world - one life at a time. We are a diverse, patient-focused, high-performing team with a commitment to quality, collaboration, and continuous improvement that enables us to deliver the maximum standard of care to our patients. We offer challenging career opportunities in a fast-paced and innovative environment and we embrace individuals who demonstrate a deep passion for problem-solving and customer service.
The Charge Reconciliation and Audit Specialist is responsible for establishing and maintaining charge capture and reconciliation processes and controls as an integral part of a multi-disciplinary Revenue Integrity team. This position acts as a liaison between clinical departments and Revenue Cycle to ensure charging practices are compliant and achieves maximum reimbursement for hospital and professional services. The specialist will support all charge improvement efforts to achieve operational efficiency, ensure revenue optimization and minimize missed charging opportunities across all hospital and offsite locations for UCSD Health. The Charge Reconciliation and Audit Specialist serves a significant role in a high-profile group tasked with improving revenue results by taking a global view of clinical and financial processes, functions, and interdependencies from care delivery to final bill generation.
Key Responsibilities:
- Independently performs audit projects at all levels of complexity. Involves preliminary survey and risk assessment activities. Under guidance, designs audit programs to accomplish review objectives.
- Conducts testing based on approved audit programs of moderate to high complexity, which may include tests of the financial and operating system processes, to identify internal control weaknesses and audit findings.
- Develops formal written reports to communicate audit results to campus management, and makes recommendations as appropriate.
- May be responsible for external audit liaison duties: coordinates external agency information requests and site visits; analyzes documentation to identify potential risk areas.
- Serve as primary contact and subject matter expert on charge related workflows for assigned service line(s)
- Review patient records and assist with account corrections, charge reconciliation based on clinical documentation
- Monitor Epic Revenue Integrity Dashboard(s)
- Expected to identify, quantify impact, and participate in the resolution of any potential or actual revenue/charge related issues.
- Advise service line leaders and their staff on proper usage of charge codes; identify opportunities for capturing additional revenue in accordance with payer guidelines; develop specifications to modify existing charge capture applications to reduce charge-related claim edits/rejections
- Review all charging related information system change requests for accuracy and appropriateness; approves additions, deletions, and modifications to charges while maintaining open communication to relevant stakeholders regarding requested changes
MINIMUM QUALIFICATIONS
Seven (7) years of related experience OR a Bachelor’s Degree in related area plus three (3) years experience of related experience. Related experience is experience in healthcare industry or coding with a focus in one or more of the following areas: charge integrity; charge reconciliation; charge compliance; charge auditing; CDM management.
Experience and proven success in practices, procedures, and concepts of the healthcare revenue cycle and its component operations, including billing, collections, charge capture, contractual adjustments, third-party reimbursements, and cash management.
Certification - Applicable professional certification through AHIMA (RHIA, RHIT, CCS, CCS-P), AAPC (COC, CPC), or must obtain within 6 months after hire.
Strong interpersonal and communication skills to present sensitive information with diplomacy and in a clear and concise manner. Presents to a wide variety of audiences, including senior management and external agencies.
Proficiencies - Advanced knowledge of revenue cycle processes and hospital/professional billing to include CDM, UB, RAs and 1500. Advanced knowledge of code data sets to include CPT, HCPCS, and ICD 10. Advanced knowledge of NCCI edits, and Medicare LCD/NCDs. Comprehensive understanding of reimbursement methodologies to include DRG, OPPS, professional and facility billing. Ability to review, analyze and interpret managed care contracts, billing guidelines, and state and federal regulations.
Abilities: Due to its service focus, this position requires strong interpersonal and communication skills, well-developed analytic and organizational skills, critical -thinking and the ability to meet deadlines while influencing, but not directly managing the work of others.
Proficient computer skills; MS Office including Word, PowerPoint, Excel and Outlook; Windows operating system and Internet.
SPECIAL CONDITIONS
- Employment is subject to a criminal background check and pre-employment physical.
- Must be able to work various hours, days, shifts, on-call and locations based on the 24-hour Medical Center's business needs.
Pay Transparency Act
Annual Full Pay Range: $59,700 - $124,300 (will be prorated if the appointment percentage is less than 100%)
Hourly Equivalent: $28.59 - $59.53
Factors in determining the appropriate compensation for a role include experience, skills, knowledge, abilities, education, licensure and certifications, and other business and organizational needs. The Hiring Pay Scale referenced in the job posting is the budgeted salary or hourly range that the University reasonably expects to pay for this position. The Annual Full Pay Range may be broader than what the University anticipates to pay for this position, based on internal equity, budget, and collective bargaining agreements (when applicable).
Job offer is contingent on successful engagement in the UC COVID-19 Vaccination program (fully vaccinated with documented proof or approved exception/deferral).
If applicable, life-support certifications (BLS, NRP, ACLS, etc.) must include hands-on practice and in-person skills assessment; online-only certification is not acceptable.
UC San Diego Health is the only academic health system in the San Diego region, providing leading-edge care in patient care, biomedical research, education, and community service. Our facilities include two university hospitals, a National Cancer Institute-designated Comprehensive Cancer Center, Shiley Eye Institute, Sulpizio Cardiovascular Center, the only Burn Center in the county, and and dozens of outpatient clinics. We invite you to join our team!
Applications/Resumes are accepted for current job openings only. For full consideration on any job, applications must be received prior to the initial closing date. If a job has an extended deadline, applications/resumes will be considered during the extension period; however, a job may be filled before the extended date is reached.
To foster the best possible working and learning environment, UC San Diego strives to cultivate a rich and diverse environment, inclusive and supportive of all students, faculty, staff and visitors. For more information, please visit UC San Diego Principles of Community.
UC San Diego Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity or sexual orientation. For the complete University of California nondiscrimination and affirmative action policy see: http://www-hr.ucsd.edu/saa/nondiscr.html
UC San Diego is a smoke and tobacco free environment. Please visit smokefree.ucsd.edu for more information.
UC San Diego Health maintains a marijuana and drug free environment. Employees may be subject to drug screening.
Application Instructions
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