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Form of workAQUA Dermatology is Florida's largest and most comprehensive full-service skin care provider in the Southeast, offering medical, surgical, and cosmetic dermatology, plastic surgery, vein care, and radiation oncology. Founded in 1998, AQUA Dermatology is the Southeast's premier dermatology practice with over 100 locations throughout Alabama, Florida, and Georgia. Our established practices and experienced physicians offer patients the highest quality outcomes and an exceptional patient experience. From common rashes to skin cancer treatments, and plastic surgery procedures to an array of vein treatments, no case is beyond our experience and expertise
The Revenue Integrity Analyst/Charge Master position will perform various functions related to the accuracy of contractual payments via review, analysis, and trends. This role will build fee and allowable schedules and report on payment/adjustment discrepancies as well as variances from contracted rates. This position will also work closely with the Billing Manager to fulfill reporting requests from the administrative team.
Essential Functions
* Maintains corporate charge master and contracted insurance allowable rates.
* Analyzes modeled contracts and fee schedules for appropriate reimbursement from commercial and governmental payors.
* Monitoring/reporting of insurance receipts as directed by leadership, identifying and researching any significant variances in cash flow.
* Reviews charge master maintenance requests to ensure requests are completed according to policy. Identifies and resolves any issues as they arise.
* Effectively and professionally communicate results, challenges, and solutions through regular reports and meetings.
* Coordinates communication of charge description master maintenance to all affected departments and updates ancillary system personnel on charge description master changes.
* Provide support and analysis by querying appropriate data, preparing reports, and making presentations of analysis, findings, and recommendations to management to establish and achieve revenue cycle goals and objectives.
* Audits account to determine denial reimbursement impact / contractual underpayment amounts according to facility contracted rates or applicable government payor reimbursement methodology.
* Tracks all denial, underpayment, and government audit follow-up activity and results in appropriate systems and updates systems promptly in regards to action taken, or results received.
* Communicates trends and unresolved issues to leadership and during regularly scheduled meetings. Maintains spreadsheet tracking denial/underpayment/government audit patterns as directed by management.
* Develops and monitors a mechanism that tracks the performance of managed care relationships.
* Project and model the potential impact of payer contracts on current and long-term financial operating plans.
* Maintains current and essential knowledge of all contracted insurance plans.
* Participates in educational activities and attends department staff meetings.
* Performs other related duties and works on special projects as requested by senior management.
Competencies
* Comprehension of physician medical practice revenue cycle and reimbursement concepts, medical coding & billing processes to aid in the implementation of regulatory standards while accurately complying with billing guidelines.
* Possesses advanced Excel expertise to include pivot tables, formulas, V-look-up, & other functions.
* Dependable and able to balance multiple priorities and accomplish tasks under tight deadlines.
* Demonstrated analytical abilities to identify and comprehend the revenue cycle system through data analysis and interpretation.
* Excellent oral and written communication skills.
* Good organizational, analytical, and time management skills.
* Ability to exercise initiative, judgment, and decision-making skills.
* Demonstrated ability to perform and maintain working relationships within the department and across all business units to foster a team environment.
* General knowledge of AQUA Policies and Procedures and dermatology as it relates to the billing
POSITION TYPE AND EXPECTED HOURS OF WORK
* Full-Time
* Monday - Friday
* 8 am - 5 pm
* Evening and weekend work may be required as job duties demand
* The position is remote, the candidate must reside in Alabama, Florida, or Georgia
QUALIFICATIONS
Education - This position requires completion of a college degree or High School Diploma with equivalent work experience.
Experience - Working knowledge of ICD-10, CPT, and HCPCS coding, fee schedule reimbursement methodology, and regulatory requirements for provider coding and reimbursement. Working knowledge of key coding concepts, such as CPT modifiers, surgical packages, medical record documentation requirements, and multiple procedure guidelines. Proficient in analyzing statistical data. General understanding of professional fee billing processes and procedures. Knowledge of medical billing software. Expert in Microsoft Office Suite (Outlook, Word, Excel, PowerPoint, Teams)
Communication - Excellent oral communication skills; ability to communicate
Work Style - Must be able to work well independently but ask for help when needed. Ability to analyze and interpret information, ability to interact and decipher information telephonically and electronically.
