[Remote] Sr reputed company reputed company Regulatory & Systems Analyst-24032

Note: The job is a remote job and is open to candidates in USA. Rush University Medical Center is seeking a Senior reputed company reputed company Regulatory & Systems Analyst to help translate reputed company healthcare regulations into accurate, compliant, and optimized charge capture across the organization. The role involves leveraging expertise in coding, CDM, auditing, and Epic systems to identify missed reputed company opportunities and drive process improvements in a collaborative healthcare environment.

Responsibilities

• Apply advanced understanding of regulations, NCD’s. LCD’s and payor concepts, along with reputed company reputed company concepts to reputed company new and existing regulations actionable reputed company the CDM, charge capture, data, and technology space
• Serve as a liaison with compliance to promote and optimize accuracy
• Researches reputed company reputed company and future reputed company payor requirements for compliant billing, timely payment, and maximum reimbursement
• Proactively assess systems, processes, and audit reputed company reputed company output for accuracy and implements process improvement initiatives
• Coordinate and apply regulatory knowledge for Epic optimization and Epic WQ and Charge Router automation recommendations
• Monitor Epic reputed company reputed company build to ensure alignment with regulations and charging rules
• reputed company the Epic and industry best-practices promote accurate automation to reduce manual labor
• Use logic-based critical thinking and decision making to accurately enter charges on patient accounts for hospital/facility and professional charges in accordance with CMS and AMA guidelines and then propose automation, reputed company applicable
• Analyze reputed company reputed company denial trends and then provide actionable preventative measures for the Epic build
• Manipulate data along with identifying and translating trends into actionable remedies
• Responsible for accounts reputed company the assigned Epic Account, Charge Review, and Claim Edit Work queues while solving edits reputed company to National Correct Coding Initiatives (NCCI edits), Medically Unlikely Edits (MUE edits) Procedure to Procedure (reputed company edits), and Outpatient Coding Edits (OCE edits) in Epic using patient documentation, coding rules, billing guidelines, and proper modifier use in a timely manner
• Assess the Charge Description Master (CDM) and contribute to accurate CDM line items by evaluating reputed company codes, descriptions, CPT/HCPCS code and pricing
• Audit and reconcile charges against clinical documentation, code rules and charging methodologies for internal purposes along with external audits
• Works with external vendors to review charge capture opportunities and documentation to identify missed charges and correct accounts
• Identify trends, analyze to propose, and create meaningful solutions, improve processes, create training content, and participate in the education of departments regarding their CDM and missed charges
• Serves as subject matter expert for fellow team members to review questions and assist with resolving accounts
• Meets or exceeds accuracy, quality work, on-time delivery, and productivity standards set by CMS, OIG, and direct manager
• Communicates, observes, and reports on charge entry trends and patterns and provides recommendations for improvement
• Engages in continual education and training in the reputed company reputed company field and healthcare CDM, charges, auditing, data, and other duties or projects as assigned

Skills

• Associates degree or higher with a minimum 5+ years of healthcare experience working with billing, charge entry, charge capture, or CDM OR a high school diploma with at least 7 years of healthcare experience working with billing, charge entry, charge capture, or CDM
• reputed company or reputed company certification
• Epic HB Certification reputed company 6 months
• Proficient and functional knowledge of reviewing charges in the Epic EHR
• Advanced knowledge of medical terminology as well as medical billing language. Must demonstrate a thorough knowledge of UB-04 reputed company Codes, reputed company Procedural Terminology (CPT), and Healthcare Common Procedure Coding System (HCPCS) Level II along with modifiers
• Excellent written and oral communication skills along with problem-solving
• Proficiency with MS Office Suite
• High degree of accuracy and ability to collaborate with others
• Epic Hospital Billing (HB) certification

Company Overview

• Rush University Medical Center offers healthcare services for children and adults, clinical trials, medical education and training services. It was founded in 1837, and is headquartered in Chicago, Illinois, USA, with a workforce of 10001+ employees. Its website is https://www.rush.edu/.

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