Develop reports to validate full charge capture for CUMG providers, paying particular attention to services provided at regional sites not on SCH’s Epic platform. Serve as CUMG point of contact regarding unclosed encounters and escalate issues related to untimely closure. Monitor CUMG Charge Review status to ensure timely charge processing and claim submission. Design and generate reports that identify coding patterns that suggest additional documentation and coding education may be helpful for CUMG providers, coordinating with the Coding Education Specialist, Pro Fee Billing and Coding and Charge Capture, as necessary.
Research and analyze CUMG coding-related denials and adjustments and serve as liaison to Compliance, Coding and Charge Capture, and Revenue Cycle teams to identify trends, root causes, and remediation tactics. Coordinate with Payor Contracting to identify and address underpayments, particularly for those services not included in the Experian underpayment tool (e.g. transplant). Coordinate with Children’s Revenue Integrity and Coding Education Staff to arrange for CUMG provider support with Epic. Serve as resource to academic departments and CUMG practice advisors regarding coding and revenue capture reports.
Maintain and enhance CUMG management and board reports, including but not limited to, the daily charge/payment report, the monthly KPI and board reports, including the Balanced Scorecard report. Lead work to develop cFTE monitoring report.
- BA or BS degree in Accounting, Finance, Business Administration, Health Care Administration or similar analytically oriented field.
- Minimum five (5) years’ of progressively responsible experience in financial analysis.
- Minimum of two (2) years’ experience in health care, with strong preference for experience in physician practice analysis.
- Experience in creating dashboards and conducting analysis to support decision-making and operational management.
- Experience working with current CPT and HCPCS coding nomenclature and rules.
- Experience with decision support systems or other financial applications, Tableau preferred.
- Experience with health care benchmarking tools.
- Experience with physician revenue cycle analysis and understanding of professional fee best practices.
- Understanding of CPT coding and RBRVS methodology.
- Experience with Epic practice management and reporting applications.
- Experience preparing effective presentations and reports using a variety of software programs (e.g., Visio, PowerPoint and dashboard reports).