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

Responsibilities

• Ensure accurate charge capture, reconciliation, and compliance for all facility and professional services for designated service line.
• Interpret and apply 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.
• Perform professional-level quality review and validation of additions, deletions, and revisions to the Charge Description Master (CDM/EAP), ensuring compliant charge code structures are available for all services within designated area.
• Conduct independent revenue integrity analyses of clinical documentation and billing outputs, requiring interpretation of coding, reimbursement, and payer rules.
• Conduct 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.
• Coordinate special focus reviews, collaborating with compliance, patient access, and clinical departments to mitigate the risk of compliance violations, audits, and potential penalties related to charging errors.
• Ensure compliance with all HIPAA privacy and security standards.
• Independently design, evaluate, and ensure implementation of revenue integrity workflows and controls, requiring application of professional judgment.
• Develop, refine, and implement efficient processes and controls to optimize revenue integrity.
• Collaborate with HIM, billing, IT, and clinical stakeholders to align workflows, resolve billing issues, and manage Epic work queues.
• Exercise 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.