ECU Health Medical Center

Role Description The Senior Reimbursement Analyst is responsible for the integrity of net revenue and providing cost report preparation, cost report appeals, audit preparation, and other duties related to the regulatory reimbursement services of ECU Health. The position maintains current knowledge of Medicare, Medicaid, and other State and Federal regulations. The Sr. Reimbursement Analyst interacts with customers and ensures value is delivered and customer satisfaction is achieved. Assists in coordination of net revenue functions related to the strategic financial planning process. The Sr. Reimbursement Analyst also assists in the improvement of internal business processes and meeting future reimbursement service needs. Responsibilities - Prepares interim estimates and annual cost reports for Medicare, Medicaid, and other State or Federal agencies for ECU Health facilities. Proficient in the use of Cost Report software. - Prepares monthly reserve models and provides thorough analysis of net revenue variances for assigned entities, including bad debt and other revenue adjustments in accordance with ECU Health policies and procedures. - Prepares Third Party Settlement estimates and maintains reconciliation of related balance sheet accounts. - Analyzes and reports changes in monthly reserves. Investigates and makes recommendations for updates to assumptions and/or methodology. - Provides projections and analytical support during fiscal year budgeted net revenue preparation. - Assists in the maintenance of standardized policies and procedures for the Reimbursement Department. - Reviews operational reports, identifies opportunities/problems, and makes recommendations for improving processes methodologies. - Trains reimbursement analysts in the department on new responsibilities. - Coordinates the Medicare, Medicaid, and other State or Federal agency cost report audits, providing supporting documentation, reviewing audit adjustments, and responding to audit findings in a timely and efficient manner. - Maintains working knowledge of NC Medicaid Programs, including but not limited to HASP, Direct and Enhanced Payments. Records appropriate entries to the applicable ECU facilities for payments received. - Completes schedules as required by the state of NC. - Maintains working knowledge of net revenue software and works with IT/Vendors to ensure information is updated timely to accurately record net revenue at ECU Health Entities. - Extracts and processes data to support review of net revenue. - Maintains working knowledge of Indirect and Direct Medical Education and provides request reimbursement analysis on Program Changes. - Supports ECU Health Financial Statement audit as it pertains to Net Revenue. Provides support for balance sheet reserves and estimates. Performs analysis for variance inquiries. - Completes special projects as required. Qualifications - Bachelor's Degree or higher required. - Minimum Five Years of Experience with Medicare and Medicaid experience in a Reimbursement Department. - Working knowledge of reimbursement regulations and complex healthcare environment is required. Requirements - Remote role (based out of Greenville, NC). - Monday - Friday day shift: 8:00 a.m. - 5:00 p.m. - Occasional weekends due to regulatory requirements. Benefits - Great Benefits Company Description ECU Health is a mission-driven, 1,708-bed academic health care system serving more than 1.4 million people in 29 eastern North Carolina counties. The not-for-profit system is comprised of 13,000 team members, nine hospitals, and a physician group that encompasses over 1,100 academic and community providers practicing in over 180 primary and specialty clinics located in more than 130 locations. The flagship ECU Health Medical Center, a Level I Trauma Center, and ECU Health Maynard Children’s Hospital serve as the primary teaching hospitals for the Brody School of Medicine at East Carolina University. ECU Health and the Brody School of Medicine share a combined academic mission to improve the health and well-being of eastern North Carolina through patient care, education, and research.

Role Description This position contributes and supports Revenue Integrity's Mission towards creating a multidisciplinary revenue integrity team to strengthen the interface between clinical departments and charge improvement process. It is a holistic approach that guides the ECU Health organization toward achieving operational efficiency, complete regulatory compliance, and total reimbursement. Under the direction of the Director of Revenue Integrity, the Revenue Integrity Analyst II plays an important role in a high-profile group tasked with improving revenue results by taking a global view of clinical and financial processes, functions and interdependencies from the provision of patient care to final bill generation. Responsibilities - Interacts with clinical department directors to monitor charge capture functions across all entities. - Evaluates current charging and coding structures and processes in clinical departments to ensure appropriate capture and reporting of revenue and compliance with government and third-party payer requirements. - Completes focused charge review assessments for assigned clinical departments and/or service lines to ensure that charges are generated in accordance with established policies and timeframes. - Advises service line leaders and their staff on proper usage of charge codes; identifies opportunities for capturing additional revenue in accordance with payer guidelines; develops specifications to modify existing charge capture applications to reduce charge-related claim edits/rejections. - Provides guidance and communication on correct change capture, coding and billing processes to clinical departments and facilities. - Monitors EPIC Revenue Integrity Dashboard(s). - Participates in moderately complex projects related to revenue integrity initiatives. - Provides support for assigned cost centers within service lines and in collaboration with your team, performs reviews related to Charge Description Master (CDM) integrity. - Assesses the accuracy of all charging vehicles, including clinical systems and dictionaries, encounter forms and other charge documents. - Analyzes changes to coding and billing rules and regulations by utilizing appropriate reference materials, internet sources, seminars and publications. - Trains and assists in daily resolution of billing edits that are holding patient claims from billing, by reviewing the medical records and other applicable documentation. General Expectations - Completes and/or attends mandatory training and education sessions within approved organizational guidelines and timeframes. - Comfortable in presenting to and interacting with levels of hospital management and with clinical leaders. - Excellent organizational and project management skills. - Strong time management, attention to detail, and follow through. - Well-developed research skills. - Interacts professionally with coworkers and customers to represent the Revenue Integrity Department positively. - Works effectively as a team contributor on all assignments. - Works independently while understanding the necessity for communicating and coordinating work efforts with other employees and organizations. - Delivers positive patient experience, where applicable. Qualifications - Education: Bachelor's degree from a recognized college or university in business, healthcare or a closely related field and a minimum of three (3) years of experience within the revenue cycle. Experience of seven (7) years or higher can be substituted for the Bachelor's degree. - License/Certifications: Applicable professional certification through AHIMA (RHIA, RHIT, CCS) or AAPC (COC, CPC) or Pharmacy Technician (CPhT, PTCB). - Experience: Three (3) to five (5) years' experience in the hospital setting, healthcare industry or coding with a focus in one or more of the following areas: charge integrity, charge reconciliation, charge compliance, selected forensic charge reviews, CDM management. EPIC HB/PB experience preferred. - Proficiencies: Advanced knowledge of revenue cycle processes and hospital/medical billing to include CDM, UB, Ras and 1500. Advanced knowledge of code data sets to include CPT, HCPCS, and ICD 10. Advanced knowledge of NCCI edits, and Medicare LCD/NCDs. Comprehensive understanding of reimbursement theories to include DRG, OPPS, HCC and managed care. Ability to review, analyze and interpret managed care contracts, billing guidelines, and state and federal regulations. - Abilities: Strong interpersonal and communication skills, well-developed analytic and organizational skills, critical thinking and the ability to meet deadlines while influencing, but not directly managing the work of others. Computer skills; MS Office including Word, PowerPoint, Excel and Outlook; Windows operating system and Internet. Requirements - Pay Range: $56,617.60 - $82,528.16/year - Remote role (based out of Greenville, NC) - Monday - Friday day shift: 8:00 a.m. - 5:00 p.m. Benefits - Great Benefits

Role Description The surgical billing specialists provide a variety of analytical, clinical, coordination, and technical duties for Perioperative Services. The surgical billing specialists are responsible for accurately charging patients in Perioperative Services. Interdepartmental and intradepartmental communication skills are essential. - Verifies schedule for charge reconciliation. - Uses multiple tools to count cases and ensures lapsed case times match. - Investigates any discrepancies. - Verifies documentation and assigns correct level charge to each procedure using clinical knowledge and experience. - Assigns each procedure a charge level based on equipment, personnel required, and supply usage. - Uses guide and experience to ensure most appropriate level is charged. - Reconciles charges using various reports, personal experience, and knowledge of cases. - Communicates in a professional manner with staff, ANM's, vendors, finance, and Materials personnel to gain any additional information needed to charge a case. - Produces and understands reports related to charge generation. - Uses technical and analytical skills while researching in multiple systems (CPM, Compurecord, HealthSpan, Lawson, and any other required) for verification purposes. - Maintains knowledge of technology (supplies, techniques, and procedures) to ensure appropriate charges are applied. - Reviews and verifies vendor contracts. - Verifies and consolidates contracts, receiving reports, and OR documentation. - Ensures all items are approved by appropriate management personnel or in value analysis committee. - Provides education to staff. - Conducts in-service education for OR staff and as required for support personnel. - Participates in orientation of new clinical staff. - Performs other related responsibilities as requested or required. - Performs in accordance with accepted procedure and responds to special requests by management in a timely manner. - Some other responsibilities including answering phone, setting up files and typing. - Demonstrates Service Excellence. - Adheres to policies and procedures. - Attends regularly scheduled staff meetings and in-service classes. - Uses tact and courtesy in all interactions with management, staff, patients, families, and vendors. Qualifications - High School plus 2 years or more of formal training/education. - Completion of approved Surgical Technology or Nursing program, applicable business training preferred. - 3 to 5 years operating room clinical experience required, previous business office or billing experience preferred. - May substitute 1 year of additional education (beyond approved 2 year RN or Surgical Technology) for 1 year of experience, up to 2 years. Requirements - Remote role (based out of Greenville, NC). - Monday - Friday day shift: 8:00 a.m. - 5:00 p.m. Pay Range $18.74 - $27.32/hr Benefits Great Benefits Company Description ECU Health is a mission-driven, 1,708-bed academic health care system serving more than 1.4 million people in 29 eastern North Carolina counties. The not-for-profit system is comprised of 13,000 team members, nine hospitals and a physician group that encompasses over 1,100 academic and community providers practicing in over 180 primary and specialty clinics located in more than 130 locations. The flagship ECU Health Medical Center, a Level I Trauma Center, and ECU Health Maynard Children’s Hospital serve as the primary teaching hospitals for the Brody School of Medicine at East Carolina University. ECU Health and the Brody School of Medicine share a combined academic mission to improve the health and well-being of eastern North Carolina through patient care, education and research.

Role Description This position is responsible for the implementation, enhancement, and support of software applications following industry standards and best practice. The analyst will be required to define requirements, system design, analysis, build/configuration, testing, implementation, documentation, and support the applications that meet the specifications of a project or service request. - Takes initiative to meet and get consensus with end users for ongoing review of workflows associated with upcoming enhancements or system changes. - Coordinates and performs cross functional team evaluation, testing, and implementation of defect patches, system upgrades and releases according to the Information Services support model and change control procedures. - Proactively evaluates and recommends business process and technology driven enhancement opportunities based on application system upgrades, releases and patches. - Ability to effectively analyze and resolve complex issues. - Provides well-written and effective professional and technical documentation. - Demonstrates ability to manage small to medium scope projects following standards and procedures set by PMO methodology. - Takes responsibility to make things happen and get things done for successful project delivery. - Stays informed on current market trends and emerging technology developments that impact the department. - Uses subject matter expertise to propose multiple alternatives and recommend optimal solution. - Makes effective decisions for self and team within scope of authority. - Adherence to Service Level Agreement (SLA). - Recommends and coordinates activities with internal and external resources as needed to improve performance. - Demonstrates effective verbal and written communication in a professional style, both inside and outside of department, with customers in mind. - Promotes cooperation and commitment within the team by working collaboratively with others and facilitating cross-team involvement. - Communicates strengths, shares expertise and draws upon other members skills to improve team and department performance. - Holds self personally accountable to meet or exceed team expectations and reinforces behavior in others. - This position is required to rotate on-call responsibilities. Application Analyst Team Overviews: - All Application Analysts are required to provide all core job duties for, but not limited to, the following applications to provide comprehensive tools for end users. - Revenue Cycle Billing Team - Professional Billing - Epic Electronic Medical Record, specifically Epic Resolute Professional Billing (SBO and non-SBO), Professional Claims, Charger Router, and associated Epic tools such as Reporting Workbench and SlicerDicer, and integrated third party applications such as Optum Claims Manager, TrustCommerce, Instamed and Availity. Qualifications - Bachelor's degree in computer science, Information Systems or Healthcare related field or relevant work experience required- or higher. - 5 + years of experience as analyst implementing vendor packaged software applications required. - Advanced knowledge and experience in leading system analysis with special emphasis on system methodologies, projects management and business process reengineering related to information systems required. - Ability to effectively support multiple complex applications and facilitate cohesive integration of software applications among IS Teams and with business and clinical operations. - Works independently and demonstrates ability to train and mentor others with quantifiable and qualitative results. - Proven ability to conduct analysis, document findings, draft plans, execute, monitor and follow up. - Advanced knowledge and experience with coordinating testing strategies to ensure accuracy, functionality and reliability of the system across modules. - Effectively leading projects including both IS and system business partners according to Information Services project methodology, within budget, and on time. - Independently motivated to seek knowledge through self-education, mentoring, etc. in areas pertaining to their current position. - Advanced knowledge of functional and technical operations of supported applications to effectively function as a consultant for IS, vendor and the business partner. - Recognized as a source of advanced knowledge and proactively functions in that capacity when sought after by others. - Obtains and maintains current primary and secondary system certifications from the vendor and continued education/learning to understand the functionality of application(s) supported as applicable to the job role. Requirements - For individual clinically trained: - Demonstrates knowledge of clinical scope of practice and workflows for roles within clinical setting. - Applies clinical knowledge and workflow design techniques to develop solutions that positively impact patient care. - Ability to communicate clinical concepts to technical team and complex system design concepts to end users. - Understands application and clinical workflow. - Responsible for analyzing user needs and developing solutions while adhering to best practice, organizational and regulatory standards. - Application Analyst III & IV are required to complete and maintain one primary Epic Certification/Accreditation directly related to the application and at least one secondary Certification/Accreditation, Proficiency, or a minimum of two Epic Badges, all determined by manager. Benefits - Pay Range: $83,636.80 - $121,904.64 - Location - Remote - #LI-REMOTE - #LI-MG1

Role Description This position contributes and supports Revenue Integrity's Mission towards creating a multidisciplinary Revenue Integrity team to strengthen the interface between clinical departments and charge improvement process. It is a holistic approach that guides the [client name] organization toward achieving operational efficiency, complete regulatory compliance, and total reimbursement. Under the direction of the Director of Revenue Integrity, this position is responsible for monitoring, identifying, correcting, with analysis of account errors prior to claim submission to include: - Discharge Not Billed (DNB) - Stop Bills (SB) - Workqueues (WQ) - Dashboards Responsibilities Daily Functions: - Assist in daily resolution of billing edits that are holding patient claims from billing, by reviewing the medical records and other applicable documentation. - Expected to identify, report, and participate in the resolution of any potential or actual revenue/charge related issues. - Coordinate Charge Description Master (CDM) error findings with CDM team. - Review patient records and assist with account fixes, charge reconciliation for other departments based on clinical documentation. - Monitor EPIC Revenue Integrity Dashboard(s). - Respond to departmental charging inquiries timely. - Provide support for assigned cost centers within service lines and in collaboration with your team. - Work with Coding and other clinical departments to identify/fix errors based on ICD/CPT Coding Guidelines and National Correct Coding Initiative edits. - Contribute in support of quarterly improvement initiatives through reviews as directed by department director or team leader. - Serve as primary service line representative for all charge related inquiries and issues and proper usage of charge codes. General Expectations: - Perform quality work within deadlines and/or Key Performance Indicators (KPIs) with or without direct supervision. - Interact professionally with coworkers and customers. - Work effectively as a team contributor on all assignments. - Work independently while understanding the necessity for communicating and coordinating work efforts with other employees and organizations. - Deliver positive patient experience, where applicable. - Complete and/or attend mandatory training and education sessions within approved organizational guidelines and timeframes. Qualifications - High school diploma or GED. - Applicable professional certification through AHIMA (CCA) or AAPC (CPC A, COC-A) are highly desirable. Must obtain professional credential within 6 months of employment. - One (1) to three (3) years of experience in the hospital setting, healthcare industry or coding. EPIC HB/PB experience preferred. - Current knowledge of revenue cycle processes and hospital/medical billing. - Understanding of components of electronic medical record. - Current knowledge of code data sets to include CPT, HCPCS, and ICD. - Current knowledge of NCCI edits, and Medicare LCD/NCDs. - Interpersonal and communication skills, analytic and organizational skills, critical thinking and the ability to meet deadlines. - Computer skills; MS Office including Word, PowerPoint, Excel and Outlook; Windows operating system and Internet. Pay Range $51,355.20 - $74,851.92/year Other Information - Remote role (based out of Greenville, NC) - Monday - Friday day shift - Great Benefits Company Description ECU Health is a mission-driven, 1,708-bed academic health care system serving more than 1.4 million people in 29 eastern North Carolina counties. The not-for-profit system is comprised of 13,000 team members, nine hospitals and a physician group that encompasses over 1,100 academic and community providers practicing in over 180 primary and specialty clinics located in more than 130 locations. The flagship ECU Health Medical Center, a Level I Trauma Center, and ECU Health Maynard Children’s Hospital serve as the primary teaching hospitals for the Brody School of Medicine at East Carolina University. ECU Health and the Brody School of Medicine share a combined academic mission to improve the health and well-being of eastern North Carolina through patient care, education and research.

Role Description Reviews medical record documentation, extracts data, and applies appropriate diagnosis and procedure codes for complex outpatient hospital, ambulatory surgery, intermediate level of inpatient accounts and behavior health to support hospital billing, internal and external reporting, research and regulatory compliance. Complies with the ICD-10-CM Official Guidelines for Coding and Reporting as well as other nationally established rules and regulations for coding assignment. - Provide code assignment for all levels of Outpatient Coding and/or Charge Entry services. - Provide code assignment for the following intermediate levels of inpatient accounts: general medicine/surgery and inpatient rehab/psych accounts. - Assigning diagnostic and procedural codes to patient records using ICD-10-CM and CPT and any other designated coding classification system in accordance with the UHDDS coding guidelines. - Assigning and sequencing codes accurately based on medical record documentation. - Assigns diagnosis/procedure codes utilizing the 3M Encoder and CAC to arrive at the most accurate code within 5 days of date of service. - Incorporates current regulatory coding requirements and guidelines appropriately. - Maintains weekly coding productivity log and provides feedback to the Manager of HIMS regarding any coding issues/problems. - Maintains coding accuracy of 95% or better. - Average number of records coded per week must meet minimum established quantitative standards per type of patient record. - Responsible for reviewing claims and correcting edits through CAC/ARMS. - Demonstrates effective computer skills for all coding functions. - Maintains confidentiality of patient information. - Participates in In-Service education, updates and conferences to remain current with coding requirements and guidelines. - Maintains AHIMA credentials. Qualifications - High School, equivalent (GED) or higher. - Associate's Degree in Health Information Technology or Bachelor's Degree in Health Information Management or higher is preferred. - One of the following AHIMA credentials is required: RHIA, RHIT, CCS. - 1 - 2 years relevant coding experience required. Requirements - Remote role (based out of Greenville, NC). - Monday - Friday day shift: 8:00 a.m. - 4:30 p.m. Benefits - Pay Range: $23.52 - $34.28/hr. - Great Benefits. Company Description ECU Health is a mission-driven, 1,708-bed academic health care system serving more than 1.4 million people in 29 eastern North Carolina counties. The not-for-profit system is comprised of 13,000 team members, nine hospitals and a physician group that encompasses over 1,100 academic and community providers practicing in over 180 primary and specialty clinics located in more than 130 locations. The flagship ECU Health Medical Center, a Level I Trauma Center, and ECU Health Maynard Children’s Hospital serve as the primary teaching hospitals for the Brody School of Medicine at East Carolina University. ECU Health and the Brody School of Medicine share a combined academic mission to improve the health and well-being of eastern North Carolina through patient care, education and research.