Senior Revenue Integrity Specialist - Clinical Rev Integrity - Full Time 8 Hour Days (Exempt) (Non-Union)

About the role

The Revenue Integrity (RI) Specialist provides leadership to the daily CDM maintenance workflow between the various entities of Keck Medical Center of USC and monitors the alignment of the various entities to the standard policy for maintaining the CDM. The Senior RI Specialist ensures the Chargemaster (CDM) is consistent with all coding and billing regulations and accurately represents services provided.

Responsibilities

• Performs maintenance to the Keck Medical Center of USC Charge Description Master (Keck & Norris) ensuring all annual updates required by Medicare and other third-party payers are up to date.
• Aids in the annual coding review and processing of updates.
• Reviews and processes requests for new code additions, code set corrections, revenue code to CPT/HCPCS code mismatch corrections, and ongoing identified changes for current systems to maintain compliance with both state and federal regulatory agencies.
• Leads and conducts meetings with Operations Leaders, Revenue Auditors, Clinical Department Staff, and Gatekeepers to address issues involving compliance with government regulations, third party payor needs, and industry standards.
• Takes the lead and exercises significant judgement and discretion on projects that have a broad, organizational impact.
• Collaborates with Revenue / Chart Audit team associated with research and resolution of account issues related to the CDM, charge capture, and other issues considered to be revenue integrity.
• 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 form of ad-hoc reports.
• Provides guidance and education to ensure that CDM’s and Charge Capture as needed of exist and newly acquired entities (i.e. Verdugo Hills) follow the standards and policies of Keck Medical Center of USC.
• Participates collaboratively with Revenue Cycle and Ancillary team in the development, execution, and follow-up of education programs for USC Administration, Managers and Staff on all issues related to the charge master, charge capture, and new applications related processes.
• Enhances professional growth and development by actively participating in team development, contributing to dashboards, and in accomplishing team, departmental, and organizational goals and objectives.

Qualifications

• Associate’s Degree in Business Administration, Accounting, Finance, Healthcare Administration, Nursing, or similar/related field.
• Specialized/technical training Certification from an accredited program of Certified Coder (CPC/CCS/COC) or Certificate of Auditing (CPMA) within one year from date of hire.
• 5 years Experience in healthcare field required.
• Related experience may include a combination of clinical service delivery (nursing or allied health), 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 methodology required.
• Must be able to implement a systematic, self-motivated approach to problem solving and be able to identify, coordinate, and optimize resources needed to execute plan.
• Proficient skills and knowledge in MS Office/Windows.

Preferred Qualifications

• Bachelor’s Degree in Business Administration, Accounting, Finance, Healthcare Administration, Nursing, or similar/related field.
• Previous hospital Chargemaster experience, including the use of CDM Maintenance software (Craneware or Med Assets).
• 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.
• Working knowledge of CPT, HCPCs and ICD9 coding principles.
• Skills and knowledge on the following software: Cerner and Craneware.

Pay

The annual base salary range for this position is $99,507.00 - $164,559.00.