Job Description

Job Description

Job Description

Wilshire hires only the brightest and most experienced professionals in the healthcare revenue cycle management industry. Wilshire will take the time to get know you and your employment history. We will then place you in a role that will lead to a path of career success.

The Wilshire Group believes that bright, professional individuals who bring their A-game deserve a seat at the table! Whatever your story, you are welcome here.

If you are a top performer looking to work for a strong revenue consulting organization and you desire to work for an organization that will recognize your strong work ethic, this is your new professional home.

This is a contracted interim position for an organization that was rated as one of the US News Best Hospitals 2022-23. They are looking for talented, dedicated team members to carry that legacy forward.

This is a 1-2 year position with the potential for medical, dental, vision, and 401(k).

Base Pay Scale: Generally starting at $80.00 per hour. Remote position with onsite travel once every other month.

Position Highlights:

• Conducts Prospective reviews of charge capture practices in the laboratory space and reports findings, provides education to staff responsible for charge capture, coordinates charge capture improvement tools in collaboration with Revenue Cycle IT teams, evaluates revenue impact, monitors ongoing compliance and expected versus actual revenue changes. Reports potential compliance issues for further analysis and follow-up.
• Facilitates clinical SME use of Epic with a focus on lab charge capture, regulatory coding, compliance and adherence to internal guidelines regarding maintenance, standard naming conventions and pricing integrity.
• In collaboration with Compliance Department, provides education to the lab department staff and stakeholders regarding CPT codes, HCPCS codes, revenue codes and modifiers and their compliance use.
• Leads projects to improve steps in revenue compliance, efficiencies in the lab charge capture process, and CDM charge structures.
• Performs basic financial analyses to report the impact of payment changes resulting from payer practices and CMS regulation changes. Reports financial impact of charge capture practice changes and corrections to current practices. Communicates findings fully with clinical departments and executive team.
• 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 Epic daily to discover and identify system compliance issues and revenue opportunities, conducts root cause analyses to correct identified charge capture issues, and reports the gross and net revenue differential resulting from each discover and correction completed.
• Develops criteria and processes for reporting revenue performance to a variety of stakeholders, including Division and Clinic Chiefs, the Director of Revenue Integrity, and others as appropriate.
• Responsible for presenting reports to a variety of audiences. Such reports will be accompanied by a thorough understanding of content and reasonable explanations for variations from the budget.

Education Qualifications

• Bachelor's degree in a work-related discipline/field from an accredited college or university

Experience Qualifications

• Five (5) years of progressively responsible, directly related work experience
• Five (5) years of Epic experience; Beaker

Required Knowledge, Skills, and Abilities

• Ability to analyze revenue data and identify trends and opportunities and the ability to present such data to a variety of audiences
• Interpersonal skills that allow ease of communication with Clinical staff and faculty
• Knowledge of coding conventions
• Current knowledge of third-party payer rules and regulations
• Knowledge of computer systems, specifically, Epic Care and related interfaces
• Ability to write, and speak to the analyses performed
• Ability to provide leadership in problem identification and issue resolution
• Ability to change the course of events through convincing arguments supported by data
• Ability to apply Critical Thinking skills to issues and situations
• Ability to mediate and solve complex work problems and issues
• Ability to effectively facilitate work groups to successful outcomes

Licenses and Certifications preferred

• CRCE-Certified Revenue Cycle Executive
• CRCP-Certified Revenue Cycle Professional
• CRIP-Certified Revenue Integrity Professional
• CRCS-Certified Revenue Cycle Specialist
• Epic Beaker Certification

Wilshire is honored that you have taken the time to review/apply to our open position. We will now take the time to review your experience and be in touch with you soon.

Job Tags

Hourly pay, Work experience placement, Interim role, Remote job,

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