Revenue Integrity Specialist

Job Summary: The Revenue Integrity Specialist serves as the key liaison and subject matter expert for assigned service line areas regarding all aspects of charge capture/charge description master processes.

" This position will lead, support, and coordinate on-going charge capture improvement initiatives for assigned service line areas; including charge reconciliation activities, new service implementation, and identification of revenue management opportunities.
" The Revenue Integrity Specialist will coordinate all Revenue Integrity activities on behalf of assigned service line areas; department charge capture education, charge audit activities, charge description master management, and monitoring of charge capture related metrics.
" This position also has a broad understanding of all areas of the revenue cycle; including Patient Financial Services (PFS), Health Information Management (HIM), and Reimbursement Services.

Skills:

" Registered nurse or other licensed health care practitioner preferred (PA/NJ licensing preferred).
Coding certification preferred
" Clinical expertise in Pediatrics preferred.
" Ability to work effectively with all members of the health care team.
" Working knowledge of chart/bill audits or ability to abstract medical information.
" Strong analytical and organizational skills.
" Excellent verbal and written communication skills.
" Must be able to work independently.
" Strong project management skills.
" Will be required to manage multiple complex projects simultaneously.
" Effective leadership skills.
" Must be detail, action, solution, and results oriented.
" Working knowledge of revenue cycle processes.
" Computer skills essential.
" Will need to use Word, Excel, PowerPoint, and Visio at a minimum.

Duties (cont'd):

2) Assesses efficiency and accuracy of revenue cycle operations for assigned clinical areas
" Functions as the Project Manager for revenue cycle process assessments 2x/year (planned)
" The assessment includes the areas of registration, charge capture, coding, documentation, billing, reconciliation, payer reimbursement, and compliance.
" Uses established project management tools, methodology to conduct revenue cycle assessments.
" Identifies project leadership team and members, defines project scope, and develops assessment plans
" Conducts assessment activities such as interviews, outcomes analysis, process flows and analysis, documentation reviews, and direct clinical observations as needed.
" Identifies quick hits and redesign opportunities for each project.
" Communicates regularly with key stakeholders about the progress, critical factors and obstacles related to each revenue cycle assessment.
" Assists in developing metrics to be used for ongoing monitoring.
" Prepares and presents high quality reports of the revenue cycle department assessment and the findings to various audiences.
" Implements quick hit items within the designated time period; Functions as a content expert resource for the redesign activities.
" Monitors revenue activity after the process improvement strategies have been implemented.
" Works toward meeting institutional goal of increasing revenue through improved charge capture processes.
" Performs all required activities to ensure proper and accurate reimbursement.
3) Conducts third party payer and other externally requested chart/bill audits
" Pre-audit will be conducted prior to scheduled audit date 100% of the time.
" Schedules audits within 10 days of the audit request 95% of the time.
" Completes post audit paperwork and sends these documents to PFS within 3 business days of finalized audit, noting the audit has been completed in EPIC
" RIS will give a copy of all the completed audit paperwork to the RI Charge Analyst within 5 business days of the audit being completed.
" Communicates significant audit findings to appropriate Department Manager and Senior Finance Partner within 2 weeks of audit completion so corrective actions will be taken as needed.

Bachelor's degree in clinical program required. Master's degree preferred.
" Minimum five (5) years of varied clinical experience as a RN, APN, or other clinical specialist preferred. Pediatric experience preferred.
" Working knowledge of coding rules required or willingness to obtain within 3 months of hire.
Experience with billing and documentation systems preferred

Duties (cont'd):

4) Maintains knowledge of clinical care, billing, coding compliance rules and other pertinent regulations
" completes 24 hours of continuing education each year
5.) Prepares formal reports and makes formal presentations on revenue cycle assessment findings on a regular basis
" Recipients may include clinical staff and department managers, members of Administration, PARC staff, etc.
" Demonstrates excellent verbal communication skills.
" Demonstrates excellent written communication skills.
" Demonstrates expert use of applications such as Word, Excel, and PowerPoint in written reports.
6.) Assists with other projects as necessary
" Supports Revenue Analytics Team with month end close.
" Contributes to Revenue Analytics providing clinical care and billing guidance for contract negotiations.
" Collaborates with Internal Audit and Billing Compliance Departments on clinical department reviews and remediation of any issues.
" Collaborates with PFS to help resolve Billing and/or Collection issues

Required Experience/Certifications:

"Bachelor's degree in clinical program required. Master's degree preferred.

" Minimum five (5) clinical experience as a RN, APN, or other related clinical specialist area.
" Previous professional work in a clinical area
Experience using billing and documentation systems

level 2a - Fully Remote

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