Sr. Revenue Guardian Denials | Revenue Integrity | Full Time

Overview

The Senior Revenue Guardian is responsible for providing support for timely, accurate and inclusive charge capture; coding assignments; billing functions and revenue routing to medium to high-complexity hospital departments through performance of record audits, evaluation of regulations and payer guidelines, monitoring work queues, execution of staff education and other related activities. This position facilitates the resolution of undercharges, overcharges and coding errors to assure appropriate and compliant revenue in addition to performing charging analysis to identify trends of missing or misdirected charges to resolve charge capture related issues. Additionally, this role is responsible for the timely respond to ADR, CERT, PERM, RAC and other third-party payer audit requests. Monitors the revenue and usage, late charge, and interface exception reports to ensure all revenue is captured and posted in the billing system.

Since the doors opened more than 60 years ago, UF Health Leesburg Hospital has continued to build upon its reputation as a leading medical center and the most comprehensive provider of health care services in the region. The hospital offers advanced cardiovascular care, including one of the largest open-heart programs in Florida. The American College of Cardiology has recognized UF Health Leesburg Hospital for its demonstrated expertise and commitment in treating patients with chest pain by awarding a Chest Pain Center Accreditation with Primary PCI and Resuscitation - its highest and best level of accreditation. The hospital also offers world-class orthopedics, minimally invasive robotic-assisted surgery, lifesaving emergency care, stroke treatment, labor & delivery, and so much more.

Qualifications

Education

• Bachelor’s degree in a health or business-related field preferred
• Associate’s degree from an accredited College or University
  
  

Licensure/Certification/Registration

• RN, LPN, RHIA or RHIT CCS, CCS-P, CPC, CPC-H, CCA and 3 years clinical, coding, auditing or related work experience, or receiving one of the certifications within 1 year of employment
  
  

Special Skills/Qualifications/Additional Training/Experience Required

• Experience with Health Information Management (HIM), Facility/Physician Billing, Charge Description Master (CDM), Denials Management, Charge Integrity, Financial Analysis or Certification in Auditing and/or Healthcare Compliance preferred.
• Knowledge or experience related to coding and/or medical record review procedures. Experience auditing medical records for billing/insurance purposes.
• Able to work independently and solve problems, as well as collaborate and share knowledge with team members.
• Demonstrated knowledge of third-party billing and collection processes, cash application processes, managed care, Medicare, Medicaid and other government programs
• Experience with Windows-based software required, including but not limited to Microsoft Windows, Outlook, Excel and Access
• Possess effective oral and written skills
• Working knowledge of multiple healthcare applications, including but not limited to SDK, EPIC, 3M and CDM maintenance software
• Excellent interpersonal and communication skills to positively interact with a variety of hospital personnel.
• Must have strong interpersonal, facilitation, coordination and customer service skills.
• Must be able to demonstrate ability to apply analysis, definition and documentation for business, systems and data processes.
• Must have analytical skills and competence in problem definition and strategy development for resolution.
• Must have ability to manage multiple projects and follow up on all projects.
• EPIC workflow and reporting experience preferred.
• Must be able to read, write, speak and understand English.