Transplant Revenue Cycle Specialist

The Transplant Charge Specialist (TCS) is responsible for the comprehensive review of charges under the transplant program and revenue capture surrounding transplant services and Medicare cost report (MCR) requirements. This includes but not limited to charge and case reviews for all potential encounters generated from transplant patients and time studies for both staff and physicians/surgeons. The TCS is responsible for the daily comprehensive abstraction, analysis and review of charges for solid organ transplant departments (i.e. heart, lung, liver, kidney, pancreas, etc.) for commercial, Medicare, hospital-based, provider-based inpatient and outpatient transplant accounts to support appropriate allocation of costs to the MCR. The TCS serves as an expert resource with comprehensive knowledge of Medicare and non-Medicare insurance and various transplant cost reporting requirements and regulations. The TCS collaborates with transplant administration and leadership; working dynamically and independently with and for the different organ teams. Guided by the finance director and/or administrator Essential Duties

1. Responsible for the daily comprehensive abstraction and review of all charges under the transplant service and any identified transplant patient. Must be able to navigate, manage, and work well with the different infrastructure and I.T. systems in place (e.g. Cerner, OTTR, PBAR, etc.). Ensures insurances are billed timely and properly, not held up by work-queue or bill-holds, and that accounts are tracked in a separate report for monthly review. Responsible for resolving any questionable charges, activities with the clinical staff and managers.
2. Reviews and directs appropriate pre-transplant evaluation charges to the Medicare cost report client account, reviews pre-transplant charges for all other payors and ensures that they are appropriately logged/reported for purposes of Cost Report preparation. Ensures that charges are entered correctly for transplant episodes, paying particular attention to the organ acquisition charge. Reviews the Medicare cost report acquisition account monthly under the supervision of the transplant director and/or administrator.
3. Ensures accuracy of transplant patients are in the correct phases of transplant including donors; that transplant events are captured correctly and organ procurements are accounted for accurately.
4. Reviews, analyze and oversees the Medicare cost report acquisition account monthly/quarterly under the supervision of the transplant director and/or administrator. Serves as an expert resource with comprehensive knowledge of Medicare and non-Medicare insurance and various transplant cost reporting requirements and regulations.
5. Provides review and expert analysis of all revenue cycle activities, expenses and cost report related activities as it relates to department operations. Responsible for compiling reports, presentations, summaries and being able to articulate and provide expert synthesis of findings.
6. Responsible for operationalizing inter-facility billing (e.g. kidney-paired donation) and be the intermediary for Keck hospital and USC care with outside recipient and donor transplant centers (e.g. CHLA). Ensures that charges related to these activities are billed correctly as prescribed or however it is appropriate.
7. Responsible for overall management of time study collection process for staff, physicians and surgeons ensuring all applicable time studies are collected. Ensures timely feedback is given to the IT team for all errors or problems arising from the time study application and ensure completion and rectification in a timely fashion.
8. Function as a secondary liaison responsible for collaborating with medical and surgical directors, the clinical and financial staff, other internal departments, and the Medicare Cost Reporting team as it pertains to the objective of this role and the department as a whole.
9. Responsible for co-managing the data submission requirements for all organ acquisition schedules in MCR. Proactively collaborates and participate in Medicare cost report audits.
10. Perform all other duties as assigned.

Required Qualifications: Req High School or equivalent Req Bachelor's Degree In related field If no Bachelor's Degree, must have a at least a High School Diploma with an additional 2 years experience in related field/clinical application(s). Req 1 year Experience in healthcare billing, coding, reimbursement, transplant financials, medical auditing, HIM coding or related healthcare. Req Working knowledge of Medicare, Medicaid, and commercial insurance policies is. Req Excellent computer skills including Microsoft outlook, word, excel, access, powerpoint. Req Strong knowledge of clinical terminology with ability to navigate and abstract clinical documentation for billing analysis. Req Excellent verbal and written communication skills. Req Strong interpersonal and analytical skills Preferred Qualifications: Pref Advanced education preferred or equivalent in years of services with the scope of hospital charge audit management. Pref 3 years Experience in healthcare billing, coding, reimbursement, transplant financials, medical auditing, HIM coding or related healthcare. Pref Good data visualization software skills (e.g. Tableau) Required Licenses/Certifications: Req Fire Life Safety Training (LA City) If no card upon hire, one must be obtained within 30 days of hire and maintained by renewal before expiration date. (Required within LA City only) The hourly rate range for this position is $29.00 ? $45.20. When extending an offer of employment, the University of Southern California considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate's work experience, education/training, key skills, internal peer equity, federal, state, and local laws, contractual stipulations, grant funding, as well as external market and organizational considerations. #J-18808-Ljbffr University of Southern California