Surgical Coder

Description

GENERAL SUMMARY

The Account Level Representative Level III provides leadership, direction, and support for delivering world class results while providing efficiency and effectiveness for the Coding / Health Information Management operations within the Revenue Cycle function of the National Spine and Pain Centers. This includes related activities specific to all billing, collections, secondary billing, A/R resolution and cash flow with respect to coding and the accurate presentation of the related ICD-10 coding. These associates will work closely with all operational areas within the National Spine and Pain Centers and the NSPC revenue cycle function such as pre-service clearance, financial management reporting, patient satisfaction and Patient Access to apply new and emerging approaches for the National Spine and Pain Centers clinical, administrative, financial and operational areas.

Further responsibilities include identifying, analyzing, and resolving all operational issues associated with the internal processing of approximately $150.0 million of accounts receivable while insuring annual cash flow of approximately $275.0 million. These responsibilities further include the management of approximately XXX revenue cycle associates with respect to $1.0 billion of gross revenue, $275.0 million in net revenue, in excess of 1.0 million encounters on an annual basis with an operating budget of in excess of $xx.xx.

The Account Representative Level III, will actively look for opportunities to maximize revenue throughout the system to transform the patient experience with a focus on improving both the patient experience and satisfaction as well as providing accountability for strategic business units that impact the patient experience and service pillars of the organization.

The Account Representative Level III will exhibit behaviors consistent with the standards for organizational values of National Spine and Pain Centers. Demonstrates actions consistent with National Spine and Pain Centers “expectations” as duties are performed on a daily basis.

Span of control includes the following areas:

· HIM/Coding

· HCC’s

· Payor Audits

· Departmental Education

· Provider Education

· Denial Resolution

· Revenue Enhancement

ESSTENTIAL JOB DUTIES

Latitude

· The Account Representative Level III, will establish the parameter of the job in conjunction with the Senior Director - Revenue Cycle, Vice President – Revenue Cycle, Chief Financial Officer and National Spine and Pain Centers senior management.

· The Account Representative Level III, will independently identify issues, seeks solutions and acts to solve the various issues. The incumbent will be proactive in problem remediation and act with the Senior Directors knowledge or permission and inform management of actions at a later time.

Administration

· Provides leadership and recommendation to the Senior Director – Revenue Cycle in operational decisions and policies.

· Responsible for the successful development and implementation of the divisions operating and capital budgets, goals, objectives, policies and procedures including monthly review, analysis and necessary corrective action plans.

· Providing updates and the necessary education, industry benchmarks and best practices to Revenue Cycle management including the respective operational leaders.

· Provides feedback and updates on a regular and consistent basis concerning current operations. Demonstrates a strong orientation to working with fellow associates in a positive and participative manner, modeling behavior that is consistent with the organization’s mission and values.

Professional Communication

· Maintains confidentiality in matters specified by law and hospital policy, especially those relating to information about sensitive patient and/or financial data.

· Interacts with patients/families, staff, and vendors with a variety of developmental and socio-cultural backgrounds.

· Maintains professional relationships and convey relevant information to other staff within the facility and applicable agencies.

Teamwork

· Works closely with other National Spine and Pain Centers departments to insure the success of the patient experience and the maximization of patient revenue.

· Demonstrates positive interpersonal relations in dealing with physicians, patients, patient families, visitors, co-workers, executive staff, employers, insurance companies, legal community, legal counsel, and governmental entities.

· Develops interdependent relationship with other National Spine and Pain Centers departments and revenue cycle, as needed.

Professional Development

· On-going involvement and required participation with respect to industry related groups and functions.

· Develops in-conjunction with senior management an on-going personal development and succession plan.

· Participates in the creation of a staff development to more fully develop and internal resources to fulfill long term objectives of the organization.

Expected Results

· Cash Collections – 102.0% of monthly target

· A/R over 90 days old – 15.0%

· Bad Debt and Charity Care Expense – 4.0% of net collectable patient revenue

· Yield Affecting Adjustments – 0.5% of net collectable patient revenue

· Gross Days Revenue Outstanding – 27.0 days

· Incremental Net Revenue Enhancement - $32.0 to $35.0 million

This job description is a summary of the primary duties and responsibilities of the position.

It is not intended to be a comprehensive listing of all duties and responsibilities. Contents are

subject to change at management's discretion.

Requirements

MINIMUM QUALIFICATIONS

A. Education, Experience and Training

· Five (5) years or more of relevant experience is preferred and may be substituted in lieu of educational requirement. Bachelor’s degree in accounting, finance or management desirable and advanced degree preferred. Health Care Certification including, but not limited to CHAM, CHAA, FHFMA would be considered a plus.

· Prefer but not required, that the candidate possess extensive knowledge of professional fee revenue cycle or health care finance/operations experience and regulatory requirements as they relate to the revenue cycle, health care operations and the clinical enterprise. Experience preferred within a similar setting of size, volume and organizational structure.

· Prefer but not required that the individual have significant experience with payors, providers, hospitals and physicians and understand the commensurate requirements for facilitating hospital and professional revenue cycle operations, health care financial operations, revenue management operations, analysis and the corresponding operational activities, financial compliance auditing, accounts receivable resolution, cash flow, billing, revenue enhancement and patient service issues. Additional requirements for this position include the following:

· Previous health care experience in revenue cycle operations and HIM preferred

· Health care financial and operational experience preferred

· Health care consulting background preferred

· Experience with the mentoring / coaching of staff

· Extensive knowledge in financial systems & healthcare applications preferred

B. Other Qualifications

· Incumbent must possess strong presentation skills with the ability to effectively communicate with many different audience levels. Familiarity with computerized applications is essential. Also, experience within a centralized business office processing hospital and professional fee claims is preferred.