Senior Manager- Revenue Improvement- Birmingham, AL
Posted on: March 17, 2020
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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- Regularly uses close visual acuity and operates computer
equipment to prepare and analyze and transmit data
- Generally works in an office environmentA dditional
- 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
Keywords: Guidehouse, Lewisville , Senior Manager- Revenue Improvement- Birmingham, AL, Executive , Lewisville, Texas
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