Revenue Integrity Specialist-(Audits & Denials) Revenue Integrity-Corporate 42nd Street- Full-Time- Days- Hybrid

About the role

The Revenue Integrity Specialist for the Mount Sinai Health System (MSHS) and the Icahn School of Medicine at Mount Sinai (ISMMS) focuses on optimizing charge capture, reconciliation, and process improvement for hospital-based revenue-producing departments and the ambulatory sites. By fostering strong, collaborative relationships across the organization, this role promotes financial stewardship and facilitates bidirectional communication with clinical departments, providers, and key stakeholders.

Responsibilities

• Ensure accurate charge capture, reconciliation, and compliance for all facility and professional services for designated service line.
• Subject matter authority responsible for interpreting and applying charge methodology for services within designated service line.
• Monitor charge baselines to identify variances, analyze causes of charge lag, and collaborate with key stakeholders to implement workflow improvements to reduce late charges.
• Subject matter authority and expert for the Charge Description Master (CDM/EAP), performing professional-level quality review and validation of additions, deletions, and revisions and ensuring compliant charge code structures are available for all services within designated area.
• Conducts independent revenue integrity analyses of clinical documentation and billing outputs, requiring interpretation of coding, reimbursement, and payer rules.
• Performs chart to bill audits to ensure accurate charge, price, and quantity, mitigating risks and ensuring compliance.
• Analyze physician and service line charges to ensure compliance with payer regulations, methodologies, and managed care contracts.
• Collaborate with compliance, patient access, and clinical departments to coordinate special focus reviews, mitigate the risk of compliance violations, audits, and potential penalties related to charging errors, and ensure compliance with all HIPAA privacy and security standards.
• Independently designs, evaluates, and ensures implementation of revenue integrity workflows and controls, requiring application of professional judgment.
• Develops, refines, and implements efficient processes and controls to optimize revenue integrity.
• Collaborates with HIM, billing, IT, and clinical stakeholders to align workflows, resolve billing issues, and manage Epic work queues.
• Exercises independent professional judgment to develop and refine the processes necessary to complete the work along with the ability to organize people and activities.

Qualifications

• Bachelor's degree in public health/administration, finance, business or a related field (clinical degree, RN, PT, OT, RT etc.,) or equivalent education and experience.
• 3-5 years working in a healthcare provider organization clinical department and/or 1-2 years working in a healthcare provider organization clinical department with 2 plus years’ experience in healthcare revenue cycle, revenue integrity, HIM or finance.
• Hospital and/or Professional Charge Experience.
• Epic experience preferred.
• Experience in one of the following areas: Pharmacy, Hematology - Oncology, Laboratory and Pathology, Faculty Practices, Cardiology, Imaging, Rehabilitation or Hospital Based Services.
• Coding certification, a plus.

Skills

• Strong understanding of clinical workflows, revenue cycle management, and Epic.
• Ability to interpret and apply complex clinical, regulatory, and reimbursement frameworks.
• Proficiency in conducting revenue integrity analyses and performing chart to bill audits.
• Excellent collaboration and stakeholder management skills.
• Effective problem-solving and process optimization abilities.

Benefits

Not specified.

Pay

$79,720 - $119,580 Annually.

Schedule

Full-time, Days, Hybrid.