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Sharp HealthCare Government Reimbursement Specialist/PFS Revenue Integrity/Sharp Healthcare/Day Shift/Full Time in San Diego, California

Facility:Corporate Offices

CitySan Diego

Department

Job Status

Regular

Shift

Day

FTE

1

Shift Start Time

Shift End Time

Bachelor's Degree

Required Qualifications

  • Bachelor's Degree In Business, Healthcare Administration, Finance, or equivalent work experience.

  • 3 Years Experience in hospital patient billing and/or compliance.

  • Experience and knowledge of government regulations related to hospital reimbursement and compliance.

Preferred Qualifications

  • Experience with Sharp's patient accounting system.

Essential Functions

  • AuditsGovernment Regulatory AuditsConducts audits of various departments and services that have been identified as areas of possible risk by management.Identifies potential risk areas via government payor updates as well as other requested audits and independent ATB audits.Tracks and follows through completion on risk areas identified. Performs 60-day post implementation audit of a government regulatory change presented via Billing Compliance Meeting.Conducts audits (routinely and on as needed basis) to ensure changes were implemented by the department(s) and report findings/recommendations at future meetings.Present findings to Revenue Cycle management and Billing Compliance Committee including recommendations.Define audit scope and audit methodology in working with Revenue Cycle Management and Billing Compliance Committee.Aid in implementation of internal controls to prevent denials and ensure government compliance.

  • Department support and teamworkProvide support to stakeholders in order to remediate billing/coding issues.Researches department charging and coding issues.Provides updates to Charge Master Specialist and AR Manager.Assists in other projects as vetted and assigned by direct manager.Using analytical skills, identify trends and problem solve.Interact with clinical, financial, compliance and management personnel with clear, concise communication, both written and verbal.

  • Job knowledgeKnowledge ManagementMonitors government payor updates and bulletins, reviews and researches all relevant requirements, regulations, and legislations.Identifies applicability to Sharp HealthCare and its stakeholders.Quantifies and records potential impact of identified risks and opportunities.Documents and distributes knowledge to all relevant parties.Maintains risk and opportunities database for government related items.Informs management and key stakeholders of upcoming training opportunities and facilitates registration of training as needed.Plan, recommend and implement necessary changes in conjunction with management in an organized manner.

  • Coordinate meetingsBilling Compliance MeetingsFacilitates coordination of communication for Medicare and Medi-Cal policy and regulation updates to stakeholders.Compiles, prepares and distributes meeting documents, assures summaries are in compliance with all Medicare and Medi-Cal billing updates/regulations, prepared in plain language summary including regulation applicability to Sharp HealthCare.Ensures accountability of action items as determined during the meeting.Collaborates with the AR Manager in planning and next steps.

Knowledge, Skills, and Abilities

  • Knowledge of medical terminology, CPT, HCPCS, ICD-10 codes and APC; as well as government payer specific utilization and their modification/use required.

  • Knowledge of Federal and State regulations as relates to hospital billing and reimbursement required.

  • Knowledge of best practices audit methodologies preferred.

  • Expert in Microsoft Office applications required.

Sharp HealthCare is an equal opportunity/affirmative action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender, gender identity, sexual orientation, age, status as a protected veteran, among other things, or status as a qualified individual with disability or any other protected class

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