Charge Assurance Rules Specialist

Vitalware – Seattle, WA

Are you a Charge Capture Rules Specialist looking for an opportunity for growth by creating great software for hospitals? Full-Time position with a national Inc. 500 SaaS Healthcare Software Company.

We are one of the fastest growing companies in America, recognized 4x by Inc. Magazine, VitalWare is a national software company in the healthcare space. We are a fast, flexible, energetic team driving innovation in healthcare. As a Charge Capture Rules Specialist, you will work with our Charge Capture product team and help build awesome software! You will have primary responsibility for maintaining our proprietary rule set aimed at improving and streamlining charge capture processes to help healthcare systems identify revenue opportunities, improve profitability, and ensure compliance with regulatory guidelines. If you have 5+ years inpatient/outpatient coding and billing experience in a hospital and experience in a physician setting you go to the top of the list! We want to talk to you and see if it is a fit for both us.

PS Our culture and work environment is legendary, which means people love us and stay! Lets talk.

Position Overview

The Charge Assurance Rules Specialist will have primary responsibility for maintaining our proprietary rule set aimed at improving and streamlining charge capture processes to help healthcare systems identify revenue opportunities, improve profitability, and ensure compliance with regulatory guidelines. This position takes direction from the VP, Product Content.

Duties and Responsibilities

  • Create and update proprietary Charge Assurance edits for inpatient, outpatient and physician claims based upon current coding and billing guidelines.
  • Collaborate with key stakeholders in the content development process to ensure accurate and consistent results that meet clients expectations.
  • Periodically evaluate results and take necessary action to resolve discrepancies or ambiguities.
  • Monitor status of compliance with service-level agreements and submit reports to the immediate manager on a regularly scheduled basis.
  • Contribute to internal discussions focused on workflow process improvement and optimization related to the Charge Assurance rules engine.
  • Regularly monitor and validate official data sources related to assigned areas of responsibility to ensure compliance with existing rules and regulations including but not limited to the Centers for Medicare & Medicaid Services (CMS), the American Medical Association (AMA), the American Hospital Association (AHA), and the Centers for Disease Control and Prevention (CDC).
  • Assume primary responsibility for responding to internal and external inquiries related to the Charge Assurance edits.
  • Additional projects and duties as assigned.

Qualifications and Experience Requirements

  • High school degree, GED or equivalent. A bachelors degree in Health Information Management or a related field from an accredited university is preferred.
  • Current coding certification from the American Health Information Management Association (AHIMA) or the American Academy of Professional Coders (AAPC).
  • Minimum of 5 years inpatient/outpatient coding and billing experience in a facility setting required. Previous auditing, consulting and/or education experience preferred.
  • Capable of researching data that may be unfamiliar and applying sound judgment when making decisions so that rule sets can be applied correctly and display results are as expected.
  • Proficiency in Microsoft Office and Adobe software suites.
  • Strong attention to detail.
  • Ability to communicate effectively with multiple audiences.
  • Self-motivated with the ability to prioritize effectively and meet deadlines in a fast-paced environment.
  • Strong customer service and communication skills, i.e., able to handle and resolve issues or objections diplomatically and respectfully.

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