Senior Clinical Revenue Integrity Specialist

About the role

The Senior Revenue Integrity Specialist plays a crucial role in the clinical charge capture process at Keck Medicine of USC. They provide leadership to the daily workflow between various entities of Keck Medical Center of USC and ensure alignment with standard policies for maintaining the Charge Description Master (CDM).

Responsibilities

• Ensures timely and accurate synchronization of data between the CDM in the billing system and CDM management tools.
• Maintains the CDM to comply with Medicare and other third-party payers' regulations and accurately represent services provided.
• Leads meetings with Operations Leaders, Revenue Auditors, Clinical Department Staff, and Gatekeepers to address compliance issues and industry standards.
• Acts as a subject matter expert for projects impacting revenue integrity and CDM, providing direction to the Revenue/Chart Audit team.
• Coordinates and provides leadership to the Revenue/Chart Audit team for research and resolution of account issues related to the CDM, charge capture, and other revenue integrity matters.
• Synchronizes CDM data between CDM and CDM Workflow & Management Tool for Keck Medical Center of USC entities on a monthly basis.
• Provides CDM data as necessary based on identified issues in the form of ad-hoc reports.
• Trains and educates clinical revenue generating departmental staff on CDM standards and policies.
• Develops and executes education programs for USC Administration, Managers, and Staff on charge master, charge capture, and new application processes.
• Enhances professional growth and development by participating in team development and contributing to dashboards.

Requirements

• Associate’s Degree in Business Administration, Accounting, Finance, Healthcare Administration, Nursing, or a related field.
• Specialized/technical training in Certified Coder (CPC/CCS/COC) or Certificate of Auditing (CPMA) within one year from date of hire.
• Five years of experience in healthcare field, including clinical service delivery, coding, provider billing, medical records, charge audit environment, CDM maintenance, Medicare/Medicaid reimbursement, managed care contractual arrangements, and patient accounting.
• Experience with inpatient and outpatient billing requirements (UB-04) and CMS Medicare reimbursement methodology.
• Knowledge of other government and third-party payer reimbursement methodologies.
• Able to implement a systematic, self-motivated approach to problem-solving and coordinate resources to execute plans.
• Proficient skills and knowledge in MS Office/Windows.

Preferred Qualifications

• Bachelor’s Degree in Business Administration, Accounting, Finance, Healthcare Administration, Nursing, or a related field.
• Experience and knowledge of hospital charging practices.
• Healthcare operations experience, particularly in an acute care hospital setting.
• Current knowledge of the Revenue cycle, specifically the flow of charges in and across hospital billing systems.
• Previous hospital Chargemaster experience, including the use of CDM Maintenance software (Craneware or Med Assets).
• Working knowledge of CPT, HCPCS, and ICD9 coding principles.
• Skills and knowledge on the following software: Cerner and Craneware.
• Registered Nurse (RN) certification from the CA Board of Registered Nursing.
• Pharmacy Technician certification from the CA DCA.

Benefits

The position offers an annual base salary range of $95,680.00 - $158,230.00, which may vary based on factors such as scope and responsibilities of the position, work experience, education/training, key skills, internal peer equity, federal, state, and local laws, contractual stipulations, grant funding, and external market and organizational considerations.