Revenue Integrity Specialist II

About the role

The Revenue Integrity Spec II, of Compliance and Revenue Integrity, is responsible for fact-finding, organization, and presentation of information in a manner that facilitates patient account management, revenue recognition and process improvement efforts.

Responsibilities

• Serves as the single point of contact for all charging work queues issues and charge tickets.
• May perform recurring data compilations from varied sources to inform management team of work queue trends and late charge analysis, etc.
• Under general direction of Health System Manager, may coordinate or monitor progress of special projects related to resolving identified late charge and/or revenue gaps or concerns.
• May require training of other CRI staff.
• May serve as co-administrator of the Epic HB charge review work queues that enables charge resolution.
• Ensures the timely completion of work assignments in accordance with established timelines.
• Performs accurate and timely coding charge posting (CPT, ICD-10, HCPCS, modifiers).
• Maintains familiarity with such issues as CMS coding regulations, Medicare rules, visits and procedures on the same day, consultation vs. referral, surgeries, etc.
• Understands and implements coding guidelines for multi-specialty practices.
• Attends seminars and workshops, as applicable, for updates on new coding rules and regulations.
• Elevates issues, as appropriate, to the Supervisor.
• Mets productivity and quality standards.
• Understands hospital coding trends by billing area, location, and provider.
• Identifies trends and issues with overall division and individual physician coding practices, as applicable.
• Follows policies and procedures pertinent to CRI & PFS Departments.
• Handles all correspondence including (but limited to) documentation and files in a professional and confidential manner.
• Supports CSHS core values, policies, and procedures.

Qualifications

• High School diploma / GED required.
• College level courses in finance, business or health insurance preferred.
• A minimum of 4 years of revenue cycle experience required, preferably including data analysis, charge capture and revenue reporting.
• At least 3 years of CPT & HCPCS coding experience preferred.