This position is responsible for reviewing contract reimbursement and identifying coding inefficiency and opportunities. The position will provide training assistance to Nautilus client's staff and our internal employees regarding the Nautilus Nextgen EPM system and industry updates, and assist physician clients with coding and insurance related issues. Analyze A/R and NextGen Work Log Manager for trends directly related to reimbursement issues to assist with improving department results. Coordinate with Credentialing to ensure that all client contracts have been obtained and updated.
Review EPIC work queues for reimbursement deficiencies and complete recoupment.
Provide coding review and recommendation for corrections.
Work denied and appeal work queues, as well as, make recommendations in relation to Account Representative Processes, when appropriate.
Address RAC and other recoupment efforts of government and PPO payors for accuracy.
Current CPC, CCS or RHIT certification required. ICD-10 certified. Two years coding experience required.
Two years of NextGen and EPIC practice management experience in Revenue Cycle operations.
Three years experience in healthcare revenue cycle management.
Extensive knowledge of insurance reimbursement policies.
Proficiency utilizing A/R management concepts to assist with identifying and maximizing accounts receivable opportunities.
Intermediate Excel experience.
Strong verbal and written communication skills.
Excellent problem-solving skills necessary.
Strong organizational and training abilities.
Ability to interact effectively and professionally with clients, other departments and management personnel.
Internal Number: MEM003854
About MemorialCare Medical Foundation
Let us introduce ourselves. We're MemorialCare, a nonprofit health system that includes four hospitals, two medical groups, imaging centers, surgical centers and much more. As one of the leading health systems in Orange County and Los Angeles County, we're confident that no matter what your needs are, we have the teams, tools and know-how to support you every step of the way.