Revenue Integrity Specialist - Clinical Rev Integrity - Full Time 8 Hour Days (REMOTE) (Exempt)[...]

University of Southern California (USC); Alhambra (CA); Remote; USD 81,000 - 134,000; Full time

Job summary

An established industry player seeks a Revenue Integrity Specialist to lead charge capture efforts and ensure compliance with coding regulations. In this pivotal role, you will maintain the Chargemaster, synchronize data across systems, and provide leadership to audit teams. You will engage with various stakeholders to enhance charge capture processes and educate staff on compliance issues. This role offers a unique opportunity to influence critical decisions in a dynamic healthcare environment, where your expertise will directly impact the efficiency and integrity of revenue cycles. If you are passionate about healthcare and compliance, this position is perfect for you.

Qualifications

• 3+ years of experience in healthcare, coding, or billing required.
• Associate's degree in relevant field or equivalent experience.

Responsibilities

• Maintain the Chargemaster and ensure compliance with regulations.
• Coordinate with departments to improve charge capture processes.

Skills

Problem Solving

Healthcare Knowledge

Compliance Knowledge

Communication Skills

Analytical Skills

Education

Associate's degree in Business Administration

Associate's degree in Accounting

Associate's degree in Healthcare Administration

Associate's degree in Nursing

Tools

MS Office

Craneware

Med Assets

Cerner

Job description

As the center of clinical charge capture, the Revenue Integrity (RI) Specialist provides leadership to the daily CDM maintenance workflow between the various entities of Keck Medical Center of USC and monitors the alignment of the various entities to the standard policy for maintaining the CDM. The RI Specialist is responsible for the timely and accurate synchronization of data between the CDM residing in the billing system and CDM management tools. The RI Specialist shall ensure that the Chargemaster (CDM) is consistent with all coding and billing regulations and accurately represents services provided. This includes ensuring all annual updates required by Medicare and other third-party payers are up to date. The RI Specialist delivers direction to the documentation of all policies and procedures regarding CDM Maintenance and charge process; and conducts meetings to evaluate department charge processes to improve charge capture and coding compliance. The RI Specialist also coordinates with Keck Medical Center of USC Administration, IS, Compliance, Clinical Informatics and Integration personnel on technology projects impacting charge entry, charge dictionaries, and charge, and provides data derived from multiple entities of Keck Medical Center of USC for the management and support of critical decisions and functions related the Chargemaster, CDM Maintenance, and the improvement of charge capture. As a subject matter expert in compliance and pricing of services, the RI Specialist responds to inquiries regarding Chargemaster issues and is responsible for supervising meetings for projects associated with educating and communicating to clinical revenue generating departmental staff regarding the CDM Maintenance process, coding updates, compliance issues, and charge capture improvement. The RI Specialist works closely with revenue auditors and provides leadership by providing direction to the revenue auditor team to all entities of Keck Medical Center of USC in the research and resolution of requests in a timely manner; and aid in the training and skill development of auditors to maximize available tools for Chargemaster and billing compliance.

Essential Duties:

• Performs maintenance to the Keck Medical Center of USC Charge Description Master (Keck & Norris) ensuring all annual updates required by Medicare and other third-party payers are up to date. Assists the Revenue Cycle in annual coding review and processing of updates.
• Reviews and processes requests for new code additions, code set corrections, revenue code to CPT/HCPCS code mismatch corrections and ongoing identified changes for current systems to maintain compliance with both state and federal regulatory agencies.
• Participates in meetings with Operations Leaders, Revenue Auditors, Clinical Department Staff, and Gatekeepers to address issues involving compliance with government regulations, third party payor needs and industry standards. May lead and conduct meetings as directed.
• Acts as a subject matter expert for projects that impact revenue integrity and CDM. Meets and/or communicates with various stakeholders for projects that impact revenue integrity and the CDM.
• Takes the lead and exercises significant judgement and discretion on projects that have a broad organizational impact.
• Coordinates and provides leadership to Revenue/Chart Audit team associated with research and resolution of account issues related to the CDM, charge capture, and other issues considered to be revenue integrity.
• Synchronizes CDM data between CDM and CDM Workflow & Management Tool for Keck Medical Center of USC entities monthly.
• Imports/extracts data from various sources and in various formats as needed to review, monitor, track, and maintain the integrity of the CDM and associated charge flow process.
• Provides CDM data as necessary based on identified issues in the form of ad-hoc reports.
• Provides guidance and education to ensure that CDMs and Charge Capture as needed of exist and newly acquired entities follow the standards and policies of Keck Medical Center of USC.
• Performs charge reconciliation activities, industry best practice research, and identifies and deploys charge capture improvement initiatives.

Required Qualifications:

• Associate's degree in Business Administration, Accounting, Finance, Healthcare Administration or Nursing.
• If no Associate's degree, an additional 2 years of experience is required.
• 3 years of experience in the healthcare field required. Related experience may include a combination of clinical service delivery (nursing or allied health), coding, billing, medical records, charge audit environment, CDM maintenance, Medicare/Medicaid reimbursement, managed care contractual arrangements, and patient accounting.
• Experience with inpatient and outpatient billing requirements (UB-04) and CMS Medicare reimbursement methodology.
• Knowledge of other government and third-party payer reimbursement methodology required.
• Must be able to implement a systematic, self-motivated approach to problem solving and be able to identify, coordinate and optimize resources needed to execute plans.
• Proficient skills and knowledge in MS Office/ Windows.

Preferred Qualifications:

• Previous hospital Chargemaster experience, including the use of CDM Maintenance software (Craneware or Med Assets).
• Experience and knowledge of Hospital billing and/or charging practices.
• Healthcare operations experience, particularly in an acute care hospital setting.
• Current knowledge of the Revenue cycle, specifically the flow of charges in and across hospital billing systems.
• Working knowledge of CPT, HCPCs and ICD9 coding principles.
• Skills and knowledge on the following software: Cerner and Craneware.

Required Licenses/Certifications:

• 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 annual base salary range for this position is $81,120.00 - $133,010.00. 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 candidates 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.

Apply here