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Vitalware

Product Implementation Consultant

PMO/BI – Dallas, Texas
Department PMO/BI
Employment Type Regular Full-time
Minimum Experience Mid-level
Compensation DOE

Are you a Product Implementation Consultant looking for an opportunity for growth at a healthcare software company? – Full-Time position with a national Inc. 500 SaaS Healthcare Software Company.

We are one of the fastest growing companies in America, recognized 3x 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 Product Implementation Consultant, you will work with our implementation team and help define the client charge audit rules, perform charge audits ultimately train our clients. You will work with data integration, product management, and service/support teams and touch different projects and be able to learn and do things that you can’t in a larger or more bureaucratic company.  If you possess a sound understanding of how charge assurance algorithms function, how they are built, and the associated implications for end users 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! Let’s talk. 

Position Summary

The Product Implementation Consultant (PIC) will work with data integration, product management and service/support teams. The PIC is adept at translating information between these areas through a sound understanding of how charge assurance algorithms function, how they are built, and the associated implications for end users. Through the combination of a systematic mindset and technical background, the PIC will build quality into VitalWare Charge Assurance processes and product(s), so that quality is maintained with growth.

This position enhances the relationship with VitalWare clients through collaboration, which leads to solutions. By a thorough analysis of data, the PIC determines why processes are not functioning, what needs to be done to address issues and how to prevent future occurrences. The PIC is not only passionate about problem solving, but also is passionate in building great products which lead to developing strong, lasting partnerships with VitalWare clients.

Duties and Responsibilities

  • Reviews algorithms for accuracy and compliance prior to product implementation.
  • Modifies rules, updates criteria/logic, which in turn updates worklists.
  • Ensures a consistent, comprehensive and effective rule implementation process.
  • Analyzes data for charge capture opportunities in hospital coding, billing, and reimbursement.
  • Analyzes data for compliance in hospital coding, billing, and reimbursement.
  • Builds a seamless workflow process to optimize client resources.
  • Identifies and capitalizes on opportunities for process improvement, auditor efficiency, and client satisfaction.
  • Monitors algorithm performance and executes prediction enhancements to increase verification rates.
  • Identifies trends and issues affecting rule performance.
  • Performs problem solving and root cause analysis when rule spikes occur.
  • Assists in establishing key performance indicators (KPIs) and metrics to achieve high performance and drive revenue.
  • Analyzes algorithm results and prepares report(s) of findings.
  • Researches, analyzes, and responds to inquiries regarding algorithms.
  • Reviews, develops, modifies, and/or adapts relevant client specific rules to ensure that client billing operations meet the joint requirements of both the entity and the Centers for Medicare and Medicaid Services (CMS).
  • Performs on-going rule inventory and management; inclusive of analysis and risk management for additions, modifications and removal.
  • Participates in discussions and decisions regarding the methodology and tools to be used for providing professional charge capture services.
  • Evaluates data and metrics to propose new strategies to improve project delivery and develop reports that portray and provide external stakeholders visibility into the project landscape.
  • Ensures projects are aligned to company priorities and associated business outcomes and are completed on time, in scope, and within budget.
  • Supports other VitalWare departments by providing user-perspective input and industry expertise to optimize client experience.

• Ensures strict confidentiality of medical records and financial records.

• Participates in continuing education activities to maintain and advance professional skill set.

• Adheres to company-wide and departmental policies and procedures.

• Embraces and promotes the general concept of good citizenship throughout VitalWare.

• Consistently demonstrates a commitment to VitalWare’s mission, vision and values when carrying out the duties of this position.

• Audits as necessary.

Qualifications and Experience Requirements

Knowledge Requirements

  • Knowledge of algorithm design, build, and management.
  • Knowledge of medical charge and code auditing concepts and principles.
  • Knowledge of medical coding and billing systems and associated regulatory requirements.
  • Knowledge of legal, regulatory, and policy compliance issues related to medical coding and billing procedures and documentation.
  • Knowledge of current and developing issues and trends in medical coding procedure(s) requirements.
  • Understanding of data management principles including table structure and relationship mapping.
  • Comprehension of Medicare medical necessity coding and billing rules and regulations.
  • Practical knowledge of healthcare provider business processes including, but not limited to, any or all of the following: documentation; clinical coding; chargemaster management; charge capture; billing; reimbursement reconciliation; or denials management.
  • Knowledge of legal, regulatory, and policy compliance issues related to medical coding and billing procedures and documentation.
  • Professional knowledge of hospital coding/billing guidelines and CMS regulations.
  • Operational knowledge of hospital charging and coding, and payer reimbursement methodology.
  • Ability to provide guidance and training to professional and technical staff in area of expertise.
  • Ability to function independently with productive time management skills.
  • Motivated and professional, with strong attention to detail.
  • Ability to work cooperatively with others as a team.
  • Ability to use independent judgment and to manage and impart confidential information.
  • Ability to analyze and solve problems.
  • Possesses strong communication and interpersonal skills.
  • Ability to clearly communicate medical information to professional practitioners and/or customers.
  • Ability to adapt and modify medical billing procedures, protocol, and data management systems to meet specific operating requirements.
  • Ability to communicate effectively both verbally and in written form.
  • Achieve and maintain assigned performance goals.
  • Strong analytical and investigational skills.
  • The ability to work effectively with Microsoft Office, and other computer programs/databases.
  • Possesses strategic and creative problem-solving skills.
  • Is oriented to quality, results and able to deliver under tight deadlines.
  • Presents oneself in a positive and professional manner.
  • Is able to follow verbal direction.
  • Is able to accurately interpret and apply regulatory and coding guidelines to real-world scenarios.
  • Exercises sound professional judgment when making decisions and communicating with others.

Skill and Ability Requirements

Talents and Personal Attributes

  • Is reliable, innovative, knowledgeable, tenacious, passionate and respectful.
  • Self-motivated with ability to work in a fast-paced environment.
  • Excellent communication and presentation skills.
  • Fanatical about client success and tenacious at driving long-term customer value.
  • Displays organizational commitment.
  • Required: Bachelor’s Degree in business, education, or healthcare-related specialty area. In lieu of a Bachelor’s degree, healthcare-related experience in excess of 10 years with evidence of undergraduate-level continuing education is required.

Education

Experience

  • Required: Minimum of 1 year recent and related experience in medical record documentation review, CPT, ICD, HCPCS and modifier coding, and/or auditing.
  • Preferred: Experience obtained in one of the following environments: acute-care hospital provider; multi-specialty clinic; ambulatory surgery center; health-care payer; healthcare regulatory entity; or healthcare software vendor. Preference given to candidates with 5+ years of recent coding and related experience in medical record documentation review, CPT, ICD, HCPCS and modifier coding, and/or auditing.

Certification

  • CCS, RHIT, RHIA, or other coding/clinical certifications, credentials, or expertise required. Certification must be obtained within first six months of employment.

VitalWare offers a full range of benefits to regular, full-time employees that support employees and eligible family members, including domestic partners and their children. These benefits include:

  • Medical, prescription drug, dental and vision coverage.
  • 401(k) savings plan.
  • Long term disability.
  • Paid time-off and Holiday pay.
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  • Location
    Dallas, Texas
  • Department
    PMO/BI
  • Employment Type
    Regular Full-time
  • Minimum Experience
    Mid-level
  • Compensation
    DOE
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