Revenue Assurance Specialist IV

About the Role

Promotes accurate assignment of system codes for billing and revenue processes by translating moderately complex charge throughput guidelines and services capture code reviews. Reviews include codes, pricing, and data integrity impacting throughput for accuracy and completeness in alignment with coding and billing guidelines. Performs account reviews and maintenance of system codes to ensure codes are updated, compliant, and accurately reflect policy and regulatory changes. Executes monitoring activities and process improvements by analyzing findings, identifying deficiencies and/or compliance issues, partnering with other departments to resolve them, and implementing corrective action plans. Provides guidance to the department, physicians, and practitioners by consulting on moderately complex coding/billing issues, charging inquiries, and relevant policies and regulations.

Responsibilities

• Promotes learning in others by proactively providing information, resources, advice, and expertise; builds relationships with cross-functional stakeholders and customers.
• Listens to, seeks, and addresses performance feedback; provides actionable feedback to others and managers.
• Pursues self-development; creates and executes plans to capitalize on strengths and develop weaknesses; leads by influencing others through technical explanations and examples.
• Adopts new responsibilities; adapts to and learns from change, challenges, and feedback; champions change and helps others adapt.
• Facilitates team collaboration to support business outcomes; completes work assignments autonomously and supports business-specific projects.
• Collaborates cross-functionally to achieve effective business decisions; provides recommendations and solves complex problems; escalates high-priority issues or risks.
• Supports the development of work plans to meet business priorities and deadlines; identifies resources to accomplish priorities.
• Identifies and capitalizes on improvement opportunities; uses influence to guide others and engage stakeholders.
• Translates moderately complex charge throughput guidelines and services into codes to facilitate accurate billing.
• Reviews codes configured in the system for proper alignment with charge throughput and coding guidelines.
• Independently analyzes regional and national policies and reimbursement practices to provide recommendations for charge integrity updates.
• Performs routine review and maintenance of system codes, including quarterly or annual reviews to ensure compliance with policy and regulatory changes.
• Conducts pre- and post-implementation assessments of automated and manual charge capture for quality and accuracy.
• Analyzes moderately complex billing issues related to charges/codes and proposes action plans to resolve them.
• Contributes to the maintenance of CPT, HCPCS codes, descriptions, revenue codes, RVU information, and generic codes.
• Provides guidance to other departments, physicians, and practitioners on moderately complex coding/billing issues and relevant policies.
• Participates in and supports trainings to improve revenue cycle processes and outcomes.
• Performs monitoring activities of documentation, charge capture, coding, billing, and compliance; records findings per policies/procedures.
• Partners with other departments to resolve deficiencies and compliance issues identified through monitoring activities.
• Communicates results of monitoring activities to senior team members and department leaders.
• Implements corrective action plans resulting from monitoring activities.

Requirements

• Minimum one (1) year of experience in a leadership role with or without direct reports.
• Minimum two (2) years of experience in medical coding/billing (e.g., ICD-10, CPT, HCPCS).
• Bachelor’s degree in Business, Finance, Health Information Management, or related field AND minimum five (5) years of experience in revenue cycle, pricing, charge description/fee schedule development, claims billing, or a directly related field.
• OR Minimum eight (8) years of experience in revenue cycle, pricing, charge description/fee schedule development, claims billing, or a directly related field.

Preferred Qualifications

• Certified Coding Specialist (CCS) OR Certified Coding Specialist - Physician-based (CCS-P) OR Certified Professional Coder (CPC) OR Certified Professional Coder - Hospital (CPC-H) OR Registered Health Information Administrator (RHIA) OR Registered Health Information Technician (RHIT).
• EPIC certification OR completion of an accredited EPIC Proficiency training program.

Skills

• Core: Ambiguity/Uncertainty Management, Attention to Detail, Business Knowledge, Communication, Critical Thinking, Cross-Group Collaboration, Decision Making, Dependability, Diversity/Equity/Inclusion Support, Drives Results, Facilitation Skills, Health Care Industry Knowledge, Influencing Others, Integrity, Learning Agility, Organizational Savvy, Problem Solving, Short- and Long-term Learning & Recall, Teamwork, Topic-Specific Communication.
• Functional: Confidentiality, Health Care Coding, Maintain Files and Records.

Benefits

Kaiser Permanente strives to offer a market competitive total rewards package and is committed to pay equity and transparency.

Pay

$87,200 - $112,750 / year. Actual base pay determined at offer will be based on labor market data, internal alignment, and a candidate's years of relevant work experience, education, certifications, skills, and geographic location.

Schedule

• Scheduled Weekly Hours: 40
• Shift: Day
• Workdays: Mon, Tue, Wed, Thu, Fri
• Working Hours Start: 08:00 AM
• Working Hours End: 04:30 PM
• Job Schedule: Full-time
• Worker Location: Flexible (must align with Kaiser Permanente's Authorized States policy)
• Travel: No
• Work Setting: Flexible