ProFee Clinical Documentation Specialist - Catholic Health

Catholic Health is one of Long Island’s finest health and human services agencies. Our health system has over 16,000 employees, six acute care hospitals, three nursing homes, a home health service, hospice and a network of physician practices across the island.

At Catholic Health, our primary focus is the way we treat and serve our communities. We work collaboratively to provide compassionate care and utilize evidence based practice to improve outcomes – to every patient, every time.

We are committed to caring for Long Island. Be a part of our team of healthcare heroes and discover why Catholic Health was named Long Island's Top Workplace!

Under the direction of the Manager, the Analyst position provides operational support to departments within physician revenue cycle including: RI, CDR, Patient Access, Follow up and Cash. Provides billing and charging support to Patient Financial Services, Revenue Integrity, and Revenue Realization consistent with enterprise-wide billing models. Ensures that charges are processed per models as well as payer policies and regulations. Responsibilities include: coordinating the loading and update of payer contract rates and updating fee schedules, performing complex financial analysis related to variance in payments from contractual agreements. Staying current on payer policy changes that impact charge capture, denials, and cash. Working with PRC teams and DTS on rules to increase revenue and decrease denials and touches based on payer requirement/regulations.

DUTIES/RESPONSIBILITIES:

• Keeps abreast of all billing and reimbursement regulations and standards to ensure compliance with any published or anticipated changes issued by governmental agencies and/or third party payors and educates staff through verbal and written communication.
• Assist the revenue cycle process by creating reports, analyzing data, identifying lost revenue, and implementing revenue cycle management strategies to maximize revenue.
• Collaborate and facilitate across revenue cycle departments to improve processes, maintain compliance and ensure information is shared with all stakeholders.
• Manage and maintain the PB Charge Master, serving as the subject matter expert and first point of contact for all charge master related items.
• Coordinate PB build in Epic of reimbursement contract rates for all payers provided by CH contract management.
• Coordinate the PB build in Epic of government reimbursement contracts.
• Perform regular variance reviews of payment discrepancies. Monitor contracted payments and notification and follow-up to outside agencies when payments are outside of contractual obligations.
• Resolve issues related to payment variances: Determine root cause of payment errors, perform appropriate billing actions to create compliant and billable claims, work with the PB Manager/department staff to resolve charge split issues based on billing models.
• Work with PRC departments and DTS to build payer rules to reduce denials and increase cash based on payer regulations.
• Perform regular reviews of all payer specific rules to see if updates or modifications are required based on payer changes.
• Develops, documents and implements processes, procedures and controls to identify and address discrepancies associated with third party payments and denials received.
• PRC managers will report issues that need carrier escalations. The coordinator will attend all carrier JOC calls and represent PRC issues. They will update the tracker and provide minutes and updates from calls to all managers with open issues. 
• Assists in development of and participates in ongoing staff educational programs.

• Participates in special projects as directed by the Manager
• Performs related duties as assigned and unrelated duties as requested.

POSITION REQUIREMENTS AND QUALIFICATIONS:

Education:

Bachelor's Degree preferred, or Associates Degree and 4 years of relevant health care experience; or an equivalent combination of education and experience.

Skills:

• Must be able to interpret payer contracts.
• Ability to stay current with governmental and commercial carrier
• Strong analytic skills
• Strong communication skills
• Must be able to perform a variety of duties, and collaborated with multiple teams.
• Must have excellent computer, time management, organizational and analytical skills with proficiency in Excel and Microsoft Office Suite as well as A/R systems and associated applications required.
• Epic experience/certification preferred.
• Coding experience and /or certification strongly preferred.

Technical Requirements:

• Must have high speed WiFi.
• Must meet technical access requirements for remote efficiency

Hybrid requirements:

• Hours must be worked during standard business hours 8-4, 9-5
• Must meet all productivity standards
• Must attend all required meetings remotely and in person as required
• Responsible to ensure the safety and condition of all CHS provided hardware
• Must have private secured workplace.

Experience:

Three to five years of health care Accounts Receivable experience of which one to two years must have been devoted to follow-up or billing responsibilities.

This range serves as a good faith estimate and actual pay will encompass a number of factors, including a candidate’s qualifications, skills, competencies and experience. The salary range or rate listed does not include any bonuses/incentive, or other forms of compensation that may be applicable to this job and it does not include the value of benefits.

At Catholic Health, we believe in a people-first approach. In addition to the estimated base pay provided, Catholic Health offers generous benefits packages, generous tuition assistance, a defined benefit pension plan, and a culture that supports professional and educational growth.