UC San Diego Health's Revenue Cycle department supports the organization's mission to deliver outstanding patient care and to create a healthier world - one life at a time. We are a diverse, patient-focused, high-performing team with a commitment to quality, collaboration, and continuous improvement that enables us to deliver the maximum standard of care to our patients. We offer challenging career opportunities in a fast-paced and innovative environment and we embrace individuals who demonstrate a deep passion for problem-solving and customer service.

The Charge Reconciliation and Audit Specialist is responsible for establishing and maintaining charge capture and reconciliation processes and controls as an integral part of a multi-disciplinary Revenue Integrity team. This position acts as a liaison between clinical departments and Revenue Cycle to ensure charging practices are compliant and achieves maximum reimbursement for hospital and professional services. The specialist will support all charge improvement efforts to achieve operational efficiency, ensure revenue optimization and minimize missed charging opportunities across all hospital and offsite locations for UCSD Health. The Charge Reconciliation and Audit Specialist serves a significant 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 care delivery to final bill generation.

Key Responsibilities:

• Independently performs audit projects at all levels of complexity. Involves preliminary survey and risk assessment activities. Under guidance, designs audit programs to accomplish review objectives.
• Conducts testing based on approved audit programs of moderate to high complexity, which may include tests of the financial and operating system processes, to identify internal control weaknesses and audit findings.
• Develops formal written reports to communicate audit results to campus management, and makes recommendations as appropriate.
• May be responsible for external audit liaison duties: coordinates external agency information requests and site visits; analyzes documentation to identify potential risk areas.
• Serve as primary contact and subject matter expert on charge related workflows for assigned service line(s)
• Review patient records and assist with account corrections, charge reconciliation based on clinical documentation
• Monitor Epic Revenue Integrity Dashboard(s)
• Expected to identify, quantify impact, and participate in the resolution of any potential or actual revenue/charge related issues.
• Advise service line leaders and their staff on proper usage of charge codes; identify opportunities for capturing additional revenue in accordance with payer guidelines; develop specifications to modify existing charge capture applications to reduce charge-related claim edits/rejections
• Review all charging related information system change requests for accuracy and appropriateness; approves additions, deletions, and modifications to charges while maintaining open communication to relevant stakeholders regarding requested changes

• Seven (7) years of related experience, education/training, OR a Bachelor's degree in related area plus three years of related experience/training. Related experience is experience in healthcare industry or coding with a focus in one or more of the following areas: charge integrity; charge reconciliation; charge compliance; charge auditing; CDM management.

• Certification - Applicable professional certification through AHIMA (RHIA, RHIT, CCS, CCS-P), AAPC (COC, CPC), or must obtain within 6 months after hire.

• Experience and proven success in practices, procedures, and concepts of the healthcare revenue cycle and its component operations, including billing, collections, charge capture, contractual adjustments, third-party reimbursements, and cash management.

• Strong interpersonal and communication skills to present sensitive information with diplomacy and in a clear and concise manner. Presents to a wide variety of audiences, including senior management and external agencies.

• Advanced knowledge of revenue cycle processes and hospital/professional 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 methodologies to include DRG, OPPS, professional and facility billing. Ability to review, analyze and interpret managed care contracts, billing guidelines, and state and federal regulations.

• Due to its service focus, this position requires 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.

• MS Office including Word, PowerPoint, Excel and Outlook; Windows operating system and Internet.

• Must be able to work various hours and locations based on business needs.

• Employment is subject to a criminal background check and pre-employment physical.