Allegheny Health Network Careers

Date Posted: 12/7/2016

Position Number: D-PRACREVA

Location: Allegheny Center

Allegheny Health Network is an integrated delivery network focused on preserving health care choice and providing affordable, high-quality care to the people in our communities.  With more than 14,000 employees including 7,400 health care professionals, nearly 200 primary care and specialty care practices, Allegheny Health Network includes seven hospitals in Pennsylvania with nearly 2,400 licensed beds.

Allegheny Health Network’s clinical expertise ranges from primary care to the most complex surgical procedures.  Services include cancer diagnosis and treatment, cardiovascular care, neurological and neurosurgical services, organ transplantation, orthopedic and rehabilitation services, and women’s health.

Department: Patient Access PO

Status: Full-Time

Union/ Non-union: Non-Union
 

Job Summary:

Provides administrative & regulatory support to the physician practice or department & physician organization's Revenue Cycle Center (RCC). Supports the development of a Revenue Cycle regulatory program through a structure that promotes compliant operations throughout the Revenue Cycle continuum. Activities include analysis (including root cause), monitoring & auditing, reporting & education with regards to Revenue Cycle training & problem resolution relative to denials and/or audit findings. Recommends and supports appropriate internal controls are implemented to achieve complete and accurate documentation & billing processes. Assists with the development of a denials management program with emphasis on medical necessity denials; collaborates and helps to optimize clinical documentation through analysis and prioritized evaluation. Assists with the development of work flows and procedures by identifying training and development needs for all processes within the Revenue Cycle, as well as appropriate hand-off for designated topics. Collaborates with physician practice and clinical departments and other stakeholders. Incumbent will be responsible for Revenue Cycle analysis and evaluation for all practices and the RCC.

Job Responsibilities:

• Responsible for financial, statistical & operational projects assigned by the Director Regulatory Affairs & Administrative Support; present detailed analysis of A/R performance & other financial reports & related outcomes/trends; validates clinical data used to support medical necessity of billed services, conducts quality assurance reviews of various billing components, technical requirements, supporting processes, systems & required documentation; reviews outcomes with wide array of people (i.e., Practice Directors, Practice Managers, Physicians [as requested], senior leadership, PO Coding Mgr, hospital case management, managed care contracting and RCC mgmt).
• Responsible for monitoring & auditing of Revenue Cycle issues; monitor Practice & RCC staff performance relative to current Revenue Cycle policies & procedures, including medical necessity issues of billed services through sample audits; research regulatory concepts for gaps & opportunities to improve Revenue Cycle compliance; identify under & over charge items for immediate resolution by the provider/practice; identify areas for risk as well as improvement - support assessments both desk level & on site.
• Provide ongoing education to providers, practices and RCC staff concerning practice management system, coding & regulatory complexities (i.e., billing & A/R management workflows, policies & requirements); develop & implement action & educational plans to target resolution of Revenue Cycle issues; identify training needs as well as appropriate hand-off for designated topics; assist with training & implementation of PM system for newly acquired Practices relative to front-end Revenue Cycle edits or other systematic issues and supportive medical record documentation.
• Perform ad hoc consultative research & coordination on current issues of Revenue Cycle regulatory risk including medical necessity denials; identifies a framework of continuous improvement to accomplish programmatic goals; facilitates meetings both internal & external; works collaboratively with system compliance leadership to coordinate & manage RAC and payer audit appeals.
• Serves as the Revenue Cycle regulatory liaison between the Practice and the RCC for efficient management of accounts receivable, point of service Revenue Cycle activity and all other areas within the Revenue Cycle area; serves as an internal audit consultant to clinical providers. Performs other duties as required.
• Performs other duties as assigned or required.

Required Qualifications:

• BS/BA degree in healthcare or Business Administration or equivalent education and experience required.
• Minimum 3 years healthcare management experience required with specific emphasis on regulatory issues and policy development; advanced knowledge of healthcare regulatory policies, practices & systems relative to Revenue Cycle.
• Microsoft skills required: Excel, Word, PowerPoint.
• Presentation and communication skills required.
• Requires critical thinking skills, decisive judgment and the ability to work with minimal supervision. Thorough working knowledge of all Professional Fee healthcare reimbursement.
• Proficient in federal program requirements and physician regulatory compliance program obligations.
• Uses systematic approach to problem solving and troubleshooting.
• Must possess excellent interpersonal & collaborative skills; ability to communicate effectively with physicians, staff members, system and hospital leadership, regulatory officials and health plan/insurance representatives.
• Must be organized & capable of multi-task management; must have the ability to generate, interpret & evaluate financial reports & other practice & network operational data to facilitate managerial decision making.
• Must possess a high degree of time management & organizational skills; ability to work professionally in handling a large volume of tasks & projects having tight deadlines & the ability to perform financial analysis.

Preferred Qualifications:

• Experience in EPIC- billing environment preferred