Senior Revenue Integrity Specialist - Clinical Rev Integrity

Veterans in Healthcare; Los Angeles (CA); On-site; USD 99,507 - 164,559; Full time

Job summary

Keck Medical Center of USC in Los Angeles is seeking a Senior Revenue Integrity Specialist – Clinical Revenue Integrity. You will lead the daily CDM maintenance workflow, ensuring the Chargemaster aligns with coding and billing regulations and payer requirements.

You will supervise revenue auditors, collaborate with administration, IS, compliance, and clinical informatics, and provide expert guidance on CDM and charge capture across the organization.

Qualifications

• Associate’s degree in a related field.
• Certification in CPC/CCS/COC or CPMA within one year of hire.
• Minimum five years of healthcare experience including coding, billing, CDM maintenance, and Medicare/Medicaid reimbursement.
• Experience with inpatient (UB-04) and CMS Medicare reimbursement methodologies.
• Knowledge of government and third-party payer reimbursement methodologies.
• Ability to coordinate resources for plan execution and problem solving.
• Proficiency in MS Office and Windows.

Responsibilities

• Maintain the Keck Medical Center of USC Charge Description Master and ensure annual updates for Medicare and payers.
• Review and process requests for code additions and corrections, and align CDM with changes.
• Lead meetings with operations leaders and auditors to address compliance issues.
• Serve as SME for projects affecting revenue integrity and the CDM.
• Coordinate and lead the Revenue/Chart Audit team to resolve CDM issues.
• Synchronize CDM data between CDM and management tool monthly.
• Import/export data to monitor CDM integrity and generate ad-hoc reports.
• Educate staff on CDM and charge capture standards across entities.
• Conduct charge reconciliation and deploy capture improvement initiatives.
• Explain charge service details as needed and collaborate on education programs.

Skills

MS Office

Windows proficiency

Coordination

Education

Associate’s degree in Business Administration, Accounting, Finance, Healthcare Administration, Nursing, or related field

Bachelor’s degree in Business Administration, Accounting, Finance, Healthcare Administration, Nursing, or related field

Tools

Cerner

Craneware

MedAssets

Job description

Senior Revenue Integrity Specialist – Clinical Revenue Integrity

Los Angeles, CA – Full Time (8‑Hour Days, Exempt, Non‑Union)

Overview

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 alignment with standard policy.

The RI Specialist is responsible for timely and accurate synchronization of data between the CDM residing in the billing system and CDM management tools. They ensure that the Chargemaster (CDM) is consistent with all coding and billing regulations, represents services accurately, and is kept up to date with Medicare and other third‑party payer requirements.

Key responsibilities include documentation of policies, conducting meetings to evaluate charge processes, coordinating with administration, IS, compliance, clinical informatics, and integration personnel on technology projects, and providing supervisory direction to revenue auditors.

Responsibilities

• Maintain the Keck Medical Center of USC Charge Description Master, ensuring all annual updates required by Medicare and other third‑party payers are current.
• Review and process requests for new code additions, code set corrections, revenue code to CPT/HCPCS code mismatches, and ongoing system changes to maintain regulatory compliance.
• Lead meetings with operations leaders, revenue auditors, clinical department staff, and gatekeepers to address compliance issues.
• Serve as subject‑matter expert for projects affecting revenue integrity and the CDM.
• Coordinate and lead the Revenue/Chart Audit team in resolving CDM and charge capture issues.
• Synchronize CDM data between the CDM and the CDM Workflow & Management Tool on a monthly basis.
• Import and extract data from various sources to monitor and maintain CDM integrity.
• Provide ad‑hoc reports based on identified issues.
• Guide and educate staff to ensure CDM and charge capture standards are followed, including newly acquired entities such as Verdugo Hills.
• Conduct charge reconciliation activities, research best practices, and deploy charge capture improvement initiatives.
• Interpret and explain details of charge services as needed.
• Collaborate with Revenue Cycle and Ancillary teams on education programs for staff regarding charge master and capture processes.
• Help develop policies and procedures for late charge monitoring and timely capture.
• Promote professional growth and development within the team.
• Participate in team, departmental, and organizational goal achievement.
• Perform other duties as assigned.

Required Qualifications

• Associate’s degree in Business Administration, Accounting, Finance, Healthcare Administration, Nursing, or a related field.
• Specialized or technical training certification from an accredited program such as Certified Coder (CPC/CCS/COC) or Certificate of Auditing (CPMA) within one year of hire.
• Minimum five years of experience in the healthcare field, including coding, provider billing, medical records, charge audit, CDM maintenance, Medicare/Medicaid reimbursement, managed care contracts, and patient accounting.
• Experience with inpatient and outpatient billing (UB‑04) and CMS Medicare reimbursement methodology.
• Knowledge of government and third‑party payer reimbursement methodologies.
• Ability to implement a systematic, self‑motivated approach to problem solving and to coordinate resources for plan execution.
• Proficient skills in MS Office and Windows.

Preferred Qualifications

• Bachelor’s degree in Business Administration, Accounting, Finance, Healthcare Administration, Nursing, or a related field.
• Previous charged master experience, including CDM maintenance software (Craneware or Med Assets).
• Experience with hospital charging practices and operations in an acute care setting.
• Knowledge of revenue cycle flow across hospital billing systems.
• Working knowledge of CPT, HCPCs, and ICD9 coding principles.
• Experience with Cerner and Craneware software.

Required Licenses & Certifications

• Certified Coder (CCS or CPC) or Certified Outpatient Coder‑COC (AAPC) or Certified Auditor (CPMA) obtained within one year of hire.
• Registered Nurse (RN) – CA Board of Registered Nursing (preferred).
• Pharmacy Technician – CA DCA (preferred).
• Fire Life Safety Training (LA City) – must obtain within 30 days of hire if not already possessed.

Annual base salary range: $99,507.00 – $164,559.00.