Evolving Role of HIM in Revenue Cycle Management
In our continuing series on workforce development trends, this post highlights the vital role of HIM in the revenue cycle. With the shift from volume to value, opportunities abound for HIM professionals to play a pivotal part in healthcare revenue cycle management—helping their organizations avoid penalties, meet compliance, ensure proper reimbursement and improve patient outcomes.
“Professionals specializing in revenue cycle management work in a variety of roles including billing management for hospitals and health systems, revenue-related data analysis, medical practice business management, and auditing coding and billing for accuracy and compliance,” says Rosann O’Dell, MS, DHSc, RHIA, clinical assistant professor, Kansas University. “To meet the job requirement, HIM students at KU are trained in management, reimbursement and finance and use classification systems for diagnosis and billing codes, as well as ethical and legal concepts.”
According to AHIIMA, revenue cycle management positions are in high demand, including the following opportunities:
- Revenue cycle auditor, revenue integrity auditor, or revenue integrity analyst—responsible for identifying areas of noncompliance in the areas of coding, charge capture and revenue cycle data collection practices
- Revenue cycle manager or revenue cycle integrity coordinator—responsible for working with practice management staff in day-to-day operations on issues related to the revenue cycle functions, and leading process improvement and training
In these positions, the HIM professional focuses on ensuring proper use of information in revenue cycle operations and meeting compliance. Knowledge of regulatory guidelines and requirements is more important than ever—working with staff and providers to make sure all regulations are met and that bills are submitted with accurate and compliant data.
With decades of experience in information governance, HIM is perfectly positioned to guide revenue cycle integrity. Likewise, clinical documentation improvement (CDI) specialists are strong candidates for careers in revenue cycle management or auditing. In addition to relevant experience, AHIMA notes some of the most important competencies for recruiters and candidates to consider:
- Strong interpersonal and communication skills
- Ability to manage multiple projects
- Problem-solving and decision-making skills
- Ability to analyze financial and operating information
- Exceptional leadership skills, especially working with a multidisciplinary team
- Ability to work independently and collaboratively
On the auditing side, knowledge and understanding in the following areas is essential:
- Medical terminology and coding
- State, federal and Medicare regulations
- Revenue cycle processes/terminology to communicate corrective action recommendations
HIM is transitioning from a distinct role in the HIM department into a broad range of competencies required to manage information and ensure data integrity throughout the healthcare enterprise. The walls are down—opening the way for HIM professionals to assume a leadership role in healthcare information technology (HIT).
On the heels of the recent Healthcare Information and Management Systems Society (HIMSS) conference and exhibition, we’ll take a close look at HIT trends expected to impact the healthcare industry in 2017. Join us for new insights and perspectives as we explore emerging opportunities for HIM. We’re on the brink of unprecedented growth for our profession!