1. Oversees the evaluation of current charging, coding, and auditing processes in Vail Health specialty clinical areas and makes recommendations to ensure optimal and accurate charge capture.
2. Provides education, feedback, and documentation to Vail Health specialty clinical areas and leadership on identified issues to support correct charging and coding at the point of charge entry. Provides guidance and education to Vail Health specialty departments on updated charging and coding practices.
3. In alignment with the Revenue Integrity department, identifies required changes to the charge description master (CDM) by understanding the federal, state, and third-party charging guidelines, assists the revenue integrity department with CDM tasks related to Vail Health Specialty clinics including charge reconciliation, clinical charge entry education, yearly Current Procedural Terminology (CPT) updates.
4. Assists departments in researching and resolving issues, edits, charging/billing errors or denials related to the charge master in accordance with regulatory guidelines.
5. Identifies opportunities for capturing additional revenue in accordance with payor guidelines; develops specifications to modify existing charge capture applications to reduce charge-related claim edits / rejections.
6. Prepares reports on non-compliance or error trends and works with the departments to facilitate compliance, ensure appropriate revenue capture, and/or reduce Accounts Receivable (AR) through efficient process flow.
7. Prepares production, openfill, backfill, no show, and other patient trend reports to ensure efficacy in patient access and availability.
8. Reviews current pricing as compared to Ambulatory Payment Classification (APC), Physician Fee Schedule (PFS) and market data. Provides back-up support to Patient Financial Services to provide procedure cost estimates in response to patient inquiries.
9. Quantifies and provides comparative data to understand the impact of how changes to the charges will financially impact the department or facility.
10. Provides CDM/charge-related data/reports for decision-making support, as requested and within scope.
11. Builds strong relationships and facilitates effective communication between hospital and clinic operations and core support departments such as Patient Access, Revenue Cycle, IT, HIM, and Compliance.
12. Role models the principles of a Just Culture and Organizational Values.
13. Perform other duties as assigned. Must be HIPAA compliant.

• Three years of related revenue cycle experience, required.
• CDM experience in an acute care organization, required.
• ICD/DRG and/or CPT/APC coding and reimbursement concepts knowledge, required.
• Facility and/or professional coding and billing knowledge, required.
• Knowledge of patient billing systems, health procedures and classification systems, required.
• Knowledge of hospital accounting systems and practices as related to patient billing, required.
• Proficiency in medical terminology, hospital charge masters, charge review, clinical record information systems, and coding methodologies, required.
• One year of specialty clinic experience, preferred.
• Experience in implementing patient billing and accounting systems, preferred.
• Experience with Cerner, preferred.

• N/A

• One of the following preferred:
  • Certification in Healthcare Revenue Integrity (CHRI) 
  • Registered Health Information Technician (RHIT)
  • Registered Health Information Administrator (RHIA)
  • Certified Professional Coder (CPC/CPC-H)
  • Certified Coding Specialist (CCS/CCS-P) or
  • Other HIM or Billing related certification preferred.

• Previous experience supporting Windows servers.
• Must possess, or be able to obtain within 90 days, the computer skills necessary to complete online learning requirements for job-specific competencies, access online forms and policies, complete online benefits enrollment, etc.

• Graduate of a coding certificate program, Associate's or Bachelor's degree in health information technology, other allied health field, business, or accounting, preferred.

Benefits at Vail Health (Full Time) Include:

• Competitive Wages & Family Benefits:
  • Competitive wages
  • Parental leave (4 weeks paid)
  • Housing programs
  • Childcare reimbursement 
• Comprehensive Health Benefits: 
  • Medical
  • Dental 
  • Vision
• Educational Programs: 
  • Tuition Assistance 
  • Existing Student Loan Repayment
  • Specialty Certification Reimbursement
  • Annual Supplemental Educational Funds
• Paid Time Off:
  • Up to five weeks in your first year of employment and continues to grow each year.
• Retirement & Supplemental Insurance:
  • 403(b) Retirement plan with immediate matching 
  • Life insurance
  • Short and long-term disability
• Recreation Benefits, Wellness & More:
  • Up to $1,000 annual wellbeing reimbursement
  • Recreation discounts
  • Pet insurance