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Manager, Revenue Integrity
AtlantiCare
Egg Harbor Township, New Jersey
Posted 8/8/2023
Job Description:
The Manager of Revenue Integrity will provide daily oversight and leadership to the Revenue Integrity team, which includes all payer audits, the Charge Description Master (CDM), charge capture processes, clinical denial appeals, OPPS Medicare claim edits and development of the Billing Determination Forms for clinical research studies. This role will include hands-on work in the review of claims held due to coding or charge edits, review of clinical documentation, the identification of corrections needed to get a claim billed and paid correctly, assistance with clinical appeals and backs up all areas of responsibilities.
This position will collaborate regularly with the Patient Accounting team related to clinical questions on claims, with the Finance team related to charge volume questions, and with various clinical leaders and staff related to the correct documentation needed to support charges and/or Medicare coverage determination rules. The position requires a high level of problem-solving skill, the ability to work independently, the organizational skills to manage multiple things at once, and the ability to effectively manage a group of highly experienced employees with diverse responsibilities. Strong computer and research skills are essential.
Qualifications:
Education (Required):
- Graduate of an accredited school of nursing as a registered nurse.
- Bachelor’s degree in nursing or related field (can be in pursuit of the degree).
License/Certification:
- Current NJ license as a registered nurse is required.
- Certification in hospital outpatient coding (COC) is preferred.
Experience:
- 3-5 years of experience in a leadership role is required, ideally in revenue integrity functions.
- 2-3 years of experience working with CPT, HCPCS and UB codes is required.
- Experience working with CDM maintenance, appeal work and billing and clinical documentation systems is strongly preferred.
- Knowledge of the interrelation between charging, coding and billing is required.
- The ability to communicate effectively with both clinical and non-clinical staff and leaders is required.
Performance Expectations:
Demonstrates the competencies as established on the Assessment and Evaluation Tool for this position.
Work Environment:
This position requires desk/computer work for a majority of the time. Essential functions of this position are listed on the Assessment and Evaluation Tool.
Reporting Relationship:
This position will report to the Director of Revenue Integrity & Utilization Management. It directly supervises the PFS Medical Audit Supervisor, the Charge Description Master Supervisor, a Revenue Integrity Nurse Auditor and a Clinical Denial Appeal Nurse. It has indirect supervision of the Medical Audit Assistant.
The above statement reflects the general details considered necessary to describe the principal functions of the job as identified and shall not be considered as a detailed description of all work requirements that may be inherent in the position.
Apply Now:
https://www.atlanticarecareers.org/jobs/333505/?utm_source=hfmanj&utm_medium=posting
AtlantiCare is an equal opportunity employer that takes affirmative action to employ and advance in employment individuals without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status or disability.
Director, Medical Audits
AtlantiCare
Egg Harbor Township, New Jersey
Full-time
Posted 8/4/2023
Job Description:
AtlantiCare, the largest healthcare organization in southeastern New Jersey, is seeking a Director, Medical Auditsto join our growing team.
The Director, Medical Audits is responsible for conducting process improvement assessments of revenue cycle operations in clinical areas with a focus on improving the accuracy and timeliness of charge capture. Assessments primarily consist of “chart-to-bill” audits, interviews with key stakeholders, direct observation of charge entry and reconciliation processes, and analysis of relevant charge data. Analyzes the assessment results and develops recommendations for process improvement.
This position will collaborate with the Finance Department and other clinical and operational areas to implement process improvement strategies. Measures and monitors compliance with regular review, interpretation and distribution of system reports. Designs new reports as needed to support charge capture metrics.
Performs follow-up and conducts education and training with lagging departments/clinical areas. Acts as the principal liaison between the Finance Department and clinical directors for charging. Functions as a resource to the Finance Department and clinical areas for charge capture, coding, documentation and reconciliation process subject matter. This job requires a high level of problem-solving. Must be able to work independently. Acts as a resource to the clinical departments. Computer skills are essential. Will need to use Word, Excel, PowerPoint and Visio at a minimum.
Qualifications:
- Education: Clinician (RN); bachelor’s degree.
- License/Certification: Registered nurse or other licensed healthcare practitioner required. Coding certification preferred.
- Experience: Five years of varied clinical experience as an RN or other clinical specialist. Bachelor’s degree in clinical program required. Master’s degree preferred. Working knowledge of coding rules required or willingness to obtain within 3 months of hire. Experience with billing and documentation systems preferred.
Performance Expectations:
- Demonstrates the competencies as established by the department and on the Assessment and Evaluation Tool for this position.
Work Environment:
- Potential for exposure to the hazards and risk of the hospital environment, including exposure to infectious disease, hazardous substances and potential injury. This position requires desk/computer work a majority of the time. Requires some walking and standing and occasional lifting up to 20 lbs.
Reporting Relationship:
- This position reports to the Director of Patient Accounting and supervises the PFS Medical Audit Coordinator.
The above statement reflects the general details considered necessary to describe the principal functions of the job as identified and shall not be considered as a detailed description of all work requirements that may be inherent in the position.
Apply:
For more information, contact the recruiter: Rebecca Leeds at [email protected]
609-389-2273
Equal Opportunity Employer. M/F/D/V.
https://www.atlanticarecareers.org/jobs/340327/?utm_source=hfmanj&utm_medium=posting&utm_campaign=3302summer23
Effective September 1, 2011, all employees of State and local government must reside in the State of New Jersey, unless exempted under law. If you already work for State or local government as of September 1, 2011, and you do not live in New Jersey, you are not required to move to New Jersey. However, if you begin your office, position or employment on September 1, 2011 or later, you must reside in New Jersey. If you do not reside in New Jersey, you have one year after the date you take your office, position or employment to relocate your residence to New Jersey. If you do not do so, you are subject to removal from your office, position or employment.
Assistant Director of Research, Investor Relations and Compliance
New Jersey Health Care Facilities Financing Authority
Posted: 7/27/2023
Definition:
Under the direction of the Director of Research and Compliance, the Assistant Director of Research, Investor Relations and Compliance oversees and participates in the daily activities of the Division. These include; research and analysis to allow the Authority to anticipate or respond to developments in the health care industry; development and maintenance of data bases to evaluate the fiscal condition of health care facilities, and design and implementation of surveillance policies and procedures to ensure that borrowers fulfill their obligations under the Authority’s loan documents and assist the Department of Health and the Department of Human Services monitor health care organizations. The Assistant Director of Research, Investor Relations and Compliance will also assist senior management in the monitoring and analysis of borrower management, governance and finances and other special projects.
Examples of Work:
- Oversee the operation of several financial data bases;
- Review data to ensure consistency and accuracy; and
- Recommend proper classification of financial elements based on accounting principles and Authority’s financial monitoring goals.
- Includes financial and statistical information reported by Hospitals, Long Term Care Facilities, and Federally Qualified Health Centers.
- Review various sources of information to determine material changes in key financial and operational indicators;
- When requested, participate with senior management at meetings with the Department of Health and other State departments or agencies as well as borrowers, trustees and credit enhancers to address areas of concern;
- Assist in the development of policies and procedures affecting the release of borrower information to investors and facilitate the exchange of information between borrowers and investors;
- Respond to inquiries from investors and others in the financial community regarding general or specific transaction-related issues or concerns;
- With the Director of the Division, supervise the Compliance Manager and Database Analyst and other staff in the Division;
- Review financial projections provided for proposed financings;
- Review financial information provided to the Authority by the Department of Health regarding Certificate of Need applications; and
- Assist the Executive Director and/or the Director of Research, Investor Relations and Compliance in performing special projects as they arise.
Knowledge and Skills:
- Thorough knowledge of accounting principles;
- Familiarity with tax-exempt and taxable financing for health care facilities;
- Familiarity with government grant programs and accounting thereof;
- Ability to conduct quantitative analyses, including development of models;
- Working knowledge of word processing, presentation, spreadsheet and data base software; Microsoft applications, particularly Access preferred;
- The ability to interpret and analyze both financial and operational data and develop formats for recording and reporting such information;
- The ability to comprehend and analyze Authority bond documents and to develop internal controls to enhance compliance monitoring activities;
- The ability to communicate effectively, both orally and in writing;
- The ability to multitask; and
- Valid Driver’s License and access to a vehicle available to travel to and from meetings.
Education/Experience:
- A Bachelor’s Degree in Accounting, Business Administration or related discipline, CPA helpful.
- A minimum of five years accounting and/or finance experience, preferably in a health care organization, public accounting firm or other similar industries.
The NJHCFFA provides a comprehensive benefits package, including health benefits, generous vacation time and a pension plan, and is located in center-city Trenton, close to major highways and within walking distance of rail transportation. Interested candidates should forward a cover letter, stating salary requirements, and a resume. Only resumes stating salary requirements will be reviewed. No phone calls please. To learn more about the NJHCFFA and its service, please visit us online at www.njhcffa.com.
***This job description is a general job description of essential job functions. It is not intended as an employment contract, nor is it intended to describe all duties someone in this position may perform. All employees of New Jersey Health Care Facilities Financing Authority (“NJHCFFA”) are expected to perform tasks as assigned by NJHCFFA supervisory/management personnel, regardless of job title or routine job duties.***
Apply:
Apply to: [email protected]