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Work Shift

Day (United States of America)

Job Summary:

The Radiation Oncology Revenue Cycle Administrator will lead and coach all Radiation Oncology facilities revenue cycle teams across the WellStar Health System. This position provides direct leadership for the enhancement of an accountability based revenue cycle team. The position will assume responsibility for ongoing professional development and maintenance of billing and coding strategies that support the revenue cycle team. The Radiation Oncology Revenue Cycle Administrator serves as sponsor for performance improvement; inspires others to seek opportunities to grow and improve their performance and successful applies evidenced based practice to ensure all targets pillar outcomes are achieved. He/she effectively uses data and technology to make decisions and proactively mitigates unnecessary risks for his/her area of responsibility providing instruction and mentoring for assigned coaches to be able to do the same. This position enables the organization to meet or exceed all licensure, regulatory and accreditation standards. He/She models the way by fostering exemplary skills in attaining effective teamwork and collaboration with physicians, staff, patients and other departments. Performs other duties related to role as assigned. This individual will develop reports and deliver them to WellStar Health System Senior Leaders, Hospital C-Suites, System Compliance Leaders, Radiation Oncology providers. They will interact and coach Physicists, Dosimetrists, Providers, Care Teams, Finance and Revenue Cycle on a routine basis and must possess exceptional communication and relational skills. The Rad Oncology Rev Cycle Administrator will translate high level, complex regulations and to perform pre-bill audits along with documentation chart audits. This highly skilled individual will be performing both technical and professional reviews because of the unique, complex nature of Radiation Oncology. Under minimal supervision, the Rad Oncology Rev Cycle Administrator provides applicable billing/coding and related reimbursement guidelines, to include federal/state laws and regulatory requirements affecting daily business operations applicable to Radiation Oncology. The position will lead the development and maintenance of reimbursement education materials, audit for coding compliance and provide/coordinate the necessary education for all radiation oncology team members. This individual will lead the interface with finance regarding revenue improvement opportunities and with reimbursement areas regarding authorization and denials process that occur within the Radiation Oncology departments.

Core Responsibilities and Essential Functions:

Leadership of Reimbursement for WellStar Health System Radiation Oncology Departments (professional and technical components): * Lead/Coach revenue process for Radiation Oncology through coordination with Compliance, Revenue cycle, Billing Department, Payment Posting, HIM, etc. * Consults with Providers and System Leaders to set long-term coding and billing strategies. * Oversee and lead from a system level precertification and/or preauthorization staff to ensure correct diagnosis coding. * Oversee and lead from a system level all coding and billing staff while ensuring charges from consult to final billing audit are correct. * Audit WellStar Health System-wide Radiation oncology billing to ensure that all services are captured and charged, and that modifiers are correctly appended. * Audit system wide Radiation oncology billing to ensure template compliance and/or documentation guidelines. * Oversee and lead from a system level to decrease denials, ensure compliance with timely filing deadlines, follow-up on appeals. * Perform a comprehensive reconciliation and monitor overall reimbursement process for all radiation in the WellStar Health System. Subject matter expert with periodic and regulatory audits for WellStar Health System Radiation Oncology Departments (professional and technical components): * Develop reports for presentation to Senior Leaders, Facility C-Suite and Physicians. * Remain current, develop and train all system-wide Radiation Oncology Billing Specialists with: * medical necessity guidelines. * payor policy changes; monitor managed care contracts * nonphysician practitioner regulations * clinical trial coverage and billing requirements * Close monitoring of external forces such as OIG, RAC, CMS, etc. in coordination with Compliance Education and training (professional and technical components) * Leads staff and physician education and provides guidance on routine basis relating to ICD-10- CM, ICD-9-CM, CPT, HCPCS coding systems. * Supports from a system level existing Billing Specialists and provides, guidance, and develops training as needed * Function as the subject matter expert during internal and external compliance audits *Works as a liaison between all payers and Wellstar Health System to ensure meeting payer needs for billing in Radiation Oncology * Updates charge master Performs other duties as assigned Complies with all Wellstar Health System policies, standards of work, and code of conduct.

Required Minimum Education:

Associates Other

Required Minimum License(s) and Certification(s):

All certifications are required upon hire unless otherwise stated.

CPC - Cert Prof Coder-Preferred
ROCC - Radiation Oncology Cert Coder within 1 Year

Additional License(s) and Certification(s):

Required Minimum Experience:

Minimum 2 years + experience in radiation oncology Required and Minimum 5 years + experience in reimbursement, documentation, and coding Required and Minimum 2 years + experience in working directly with and training Physicians and staff. Required and Clinical background in radiation oncology strongly Preferred

Required Minimum Skills:

Individual must have an ability to communicate clearly, concisely, and in a manner that develops and promotes trust; must have skillset to influence senior leaders to gain acceptance of best practice in workflow design, process improvement, and other identified needs. Individual must have thorough knowledge of CPT-4 procedural coding methodology with ICD-10, ICD-9 diagnosis and HCPCS coding required. Extensive knowledge of government regulations and applicable reimbursement laws and regulations preferred. Must be available for up to travel within the Wellstar Health System footprint.

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