Revenue Integrity Specialist

Insight Global; Annapolis (MD); On-site; USD 68,000 - 102,000; Full time

Job summary

A leading company is seeking a Revenue Integrity Specialist in Annapolis, MD, responsible for charge controls and reconciliation within a healthcare system. The ideal candidate will analyze billing discrepancies, support compliance, and provide training on coding practices. Join a dynamic team dedicated to enhancing revenue integrity and operational efficiency.

Benefits

Medical insurance

Vision insurance

401(k)

Qualifications

• Experience with revenue cycle systems and charge reconciliation.
• Knowledge of CPT, ICD9, ICD-10 coding.
• Ability to perform audits and resolve billing inconsistencies.

Responsibilities

• Oversee system charge controls and develop charge reconciliation functions.
• Analyze data within the CDM and assign codes to maintain charge integrity.
• Generate reports and facilitate communications between departments.

Skills

Problem solving

Data analysis

Communication

Education provision

Job description

This range is provided by Insight Global. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more.

Base pay range

$68,000.00/yr - $102,000.00/yr

Direct message the job poster from Insight Global

Insight Global is seeking a Revenue Integrity Specialist to support a large healthcare system based out of Annapolis, MD. The candidate is responsible for overseeing and maintaining specifically assigned system Charge controls, developing enhanced charge reconciliation functions at the department level, CDM maintenance, and governmental updates related to Revenue Integrity and Compliance. Responsibilities are to resolve issues and assist others with resolving problems related to Revenue Integrity. Reviews system charge reports and identifies trends, educational needs, workflow problems, and potential system issues. Generates monthly reconciliation reports and facilitates daily/weekly calls to review the data with the department's heads, hospital administrators, and CBOs. Ensures that any reconciliation issues are resolved promptly.

The position will require reviewing specific account details to support other employees, CBO staff, or Administration when there are questions regarding the charge reconciliation process. They will analyze revenue cycle systems, including reporting data to maintain acceptable reconciliation performance, compliance, user satisfaction, and help develop greater efficiencies to identify charge enhancement opportunities. This position will determine the need for claims to be adjudicated with no further review, review records, or facilitate an onsite audit at the hospital. Develops and documents hospital claims review and audit policies. The analyst will investigate provider aberrant/fraudulent billing practices utilizing paid claim data and review medical records. Provides education to employees and provider offices as needed to understand correct claim coding, use of CPT, ICD9, ICD-10 HCPCS, etc.

• Pulls weekly performance reports and distributes them to organizational stakeholders. Analyzes the reports and summarizes any significant changes or trending;
• Generates daily reconciliation reports. Distributes the results and facilitates calls between the departments, CBO, and Administration to resolve any issues;
• Manages, coordinates, updates, and implements the Charge Description Masters ("CDM");
• Provides assistance and analysis to all levels of clinical management in support of suggested, requested, and mandated changes to the CDM;
• Provides education and in-service training to clinical departments concerning the use of proper CPT-4 Codes or charge codes;
• Performs all other duties as assigned or required, including account research, problem-solving any assigned research requests from the facilities, report writing as needed, etc.;
• Conducts review of the chargemaster and updates as appropriate to enhance revenue for clinical departments;
• Conducts audits of Corporate CDM against all individual department CDM systems;
• Analyzes data within the CDM and assigns CPT/HCPCS and revenue codes to the ChargeMaster;
• Review revenue cycle systems and clinical systems to maintain charge integrity and develop greater efficiencies for charge recognition;
• Responsible for making CDM related decisions that require a higher-level analysis and investigation;
• Identifies billing irregularities on hospital bills and recommends the next level of review, including telephonic discussions with the hospital, referral to the vendor, or onsite audit at the hospital. Recommends solutions to resolve billing inconsistencies.

Seniority level

• Seniority level

  Associate

Employment type

• Employment type

  Full-time

Job function

• Job function

  Business Development, Analyst, and Finance

• Industries

  Hospitals and Health Care

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Inferred from the description for this job

Medical insurance

Vision insurance

401(k)

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