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Senior Manager- Revenue Improvement- Birmingham, AL

Company: Guidehouse
Location: Lewisville
Posted on: March 17, 2020

Job Description:

With a unique blend of large firm resources and an entrepreneurial collaborative culture, Guidehouse is where your purpose, passion, and expertise transform organizations. Guidehouse is a leading global provider of consulting services to the public and commercial markets with broad capabilities in management, technology, and risk consulting. We help clients address their toughest challenges with a focus on markets and clients facing transformational change, technology-driven innovation and significant regulatory pressure. Across a range of advisory, consulting, outsourcing, and technology/analytics services, we help clients create scalable, innovative solutions that prepare them for future growth and success. Headquartered in Washington DC, the company has more than 7,000 professionals in more than 50 locations. If youre passionately motivated to make a difference and deliver exceptional work, we invite you to learn more about your career opportunities at www.guidehouse.comInterested in working with talented people to help develop innovative solutions to some of societys most complex and challenging problems? We are Guidehouse, a leading consulting firm serving the public sector and commercial clients with specialized capabilities in strategy, technology, and risk management. You may not yet know our name, but we have a rich history. Guidehouse is a combination of PwCs former public sector practice and Navigants deep expertise in energy, financial services and healthcare.We offer an exciting, fast-paced environment that fosters intellectual growth and rewards individuals based on impact, not tenure. Our firm is at the forefront of an emerging model solving complex problems that stretch across government and private companies, affording our people the opportunity to be on the cutting edge of the consulting profession. By focusing on markets facing transformational change, technology-driven innovation, and significant regulatory pressure, our employees also develop and deploy world class knowledge and problem solving that leads to breakthrough solutions.Our healthcare segment is comprised of consultants, former provider administrators, clinicians, and other experts with decades of strategy, operational/clinical consulting, managed care services, digital health, revenue cycle management, and outsourcing experience. Professionals collaborate with hospitals and health systems, physician enterprises, payers, government, and life sciences entities, providing performance improvement and business process management solutions that help them meet quality and financial goals. You will make an immediate impact from day one, working with a team to provide end-to-end solutions. We dont simply put band-aids on our clients issues, we are working side-by-side with them. Are up for the challenge?Business Process Management unites the strengths of four category-leading companies to address the complexities of todays healthcare system. We design, develop and implement integrated, patient-centered solutions for sustained improvements in performance and profitability, working collaboratively across a spectrum of customers that encompasses hospitals, health systems, physician practice groups and payers.

  • Collaborate with providers, clinical management and clinical associates to improve the overall quality and effectiveness related to accurate and complete charge capture.
  • Perform in depth analysis of current billing and coding activity.
  • Perform reviews of documentation as it related to correct coding, both services performed and diagnosis selection.
  • Provide feedback, supporting documentation and suggestions or assistance in implementing accurate and efficient charge capture.
  • Engaged participation will be required in project management activities for assigned new initiatives within the MSO, Health Services Foundation and Health System.
  • Act as a liaison to providers, clinical associates, and clinical departments related to coding initiatives, changes, coding and billing updates.
  • Coordinate charge capture activities, when appropriate, with hospital HIM/CDM group to ensure all coding processes and systems maintained are in sync for submission of procedure codes.
  • Participate in weekly Workflow 10 meetings, to manage and complete billing data in the SharePoint spreadsheets for code additions to Playbooks and Cerner Medications requested by the providers and clinical managers by validating codes, descriptions and necessary code logic.
  • Research new procedure requests for departments and Workflow 10 Clinical Informatics representatives and provide education on billing requirements.
  • Assist with charge capture testing review as requested.
  • Participate in MSO Monthly Compliance Meetings and complete education and assignments as delegated.
  • Participate in Physician and Revenue Cycle Leadership Meetings and provide slides that update leadership on new billing processes or requirements and process improvement opportunities.
  • Participate in Payer Representative on-site meetings (Blue Cross and Palmetto) and take learned regulations and billing information back to appropriate providers, clinical associates, MSO associates and/or management.
  • Create spreadsheets from CMS files of new CPT and HCPCS code additions/deletions/revisions for Workflow 10 committee and insure that correct processing of updates is completed prior to effective dates.
  • Complete annual new code spreadsheets for ICD-10, CPT and HCPCS codes to include system logic build.
  • Create RVU Warehouse Table each year from CMS file for Decision Support with GPCI calculations for facility and non-facility services.
  • Assist with payer fee schedule review and load annually.
  • Complete annual fee schedules for new codes for all anticipated dictionaries (Main fee schedule and modifiers 26, 82, AS, etc. as warranted by payer fee schedules).
  • Process and approve requests to add new CPT, HCPCS and/or dummy codes and fees (with system logic via the UAHSF MSO Application) with calculation of fees bases on UAB formulas.
  • Attend departmental meetings to learn departments operations and contacts, as well as, to answer questions or provide education on billing codes and/or requirements for service reimbursement.
  • Assist department liaisons with coding and compliance issues and attend departmental meetings as requested.
  • Assist MSO associates with billing research and provider communications when services and documentation require clarification and/or corrections.
  • Assist Patient Financial Services and clinical associates/managers with patient complaints and billing questions to include contacting providers for authorization of coding/diagnosis corrections.
  • Process coding corrections for HSF and hospital charges based on medical record documentation and coding requirements (payer policies, LCDs, etc.).
  • Assist IT and Compliance with GPRO reporting by participating in Primaris calls and assisting with logic development/review for reporting regulations the first quarter of each year.
  • Review paper charge tickets for coding updates annually (Diagnosis, CPT and HCPCS) and provide deleted and new code updated to IT department for changes prior to effective dates.
  • Bachelors degree, previous managerial experience and five (5) years medical coding/billing experience.
  • Advanced computer skills.
  • Extensive IDX Showcase and Microsoft Office skills.
  • Experience may substitute for degree requirement.
  • Certified Professional Coder (CPC) or a comparable coding certification (e.g. AHIMA CCS-P).
  • Strong conceptual, as well as quantitative and qualitative analytical skills
  • Work as a member of a team as well as be a self-motivator with ability to work independently
  • Constantly operates a computer and other office equipment to coordinate work
  • Regularly uses close visual acuity and operates computer equipment to prepare and analyze and transmit data
  • Generally works in an office environmentA dditional Requirements
    • This position requires successful completion of a background check and employment verification.
    • The successful candidate must not be subject to employment restrictions from a former employer (such as a non-compete) that would prevent the candidate from performing the job responsibilities as described.Guidehouse is an Equal Employment Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, citizenship status, military status, protected veteran status, religion, creed, physical or mental disability, medical condition, marital status, sex, sexual orientation, gender, gender identity or expression, age, genetic information, or any other basis protected by law, ordinance, or regulation.Guidehouse will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of applicable law or ordinance including the Fair Chance Ordinance of Los Angeles and San Francisco.If you have visited our website for information about employment opportunities, or to apply for a position, and you require an accommodation, please contact Guidehouse Recruiting at 1-571-633-1711 or via email at RecruitingAccommodation@guidehouse.com . All information you provide will be kept confidential and will be used only to the extent required to provide needed reasonable accommodation.Guidehouse does not accept unsolicited resumes through or from search firms or staffing agencies. All unsolicited resumes will be considered the property of Guidehouse and Guidehouse will not be obligated to pay a placement fee.Rewards and BenefitsGuidehouse offers a comprehensive, total rewards package that includes competitive compensation and a flexible benefits package that reflects our commitment to creating a diverse and supportive workplace.

Keywords: Guidehouse, Lewisville , Senior Manager- Revenue Improvement- Birmingham, AL, Executive , Lewisville, Texas

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