Senior Revenue Integrity Specialist - Clinical Rev Integrity

Senior Revenue Integrity Specialist – Clinical Revenue Integrity Los Angeles, CA – Full Time (8‑Hour Days, Exempt, Non‑Union) Overview As the center of clinical charge capture, 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 alignment with standard policy. The RI Specialist is responsible for timely and accurate synchronization of data between the CDM residing in the billing system and CDM management tools. They ensure that the Chargemaster (CDM) is consistent with all coding and billing regulations, represents services accurately, and is kept up to date with Medicare and other third‑party payer requirements. Key responsibilities include documentation of policies, conducting meetings to evaluate charge processes, coordinating with administration, IS, compliance, clinical informatics, and integration personnel on technology projects, and providing supervisory direction to revenue auditors. Responsibilities Maintain the Keck Medical Center of USC Charge Description Master, ensuring all annual updates required by Medicare and other third‑party payers are current. Review and process requests for new code additions, code set corrections, revenue code to CPT/HCPCS code mismatches, and ongoing system changes to maintain regulatory compliance. Lead meetings with operations leaders, revenue auditors, clinical department staff, and gatekeepers to address compliance issues. Serve as subject‑matter expert for projects affecting revenue integrity and the CDM. Coordinate and lead the Revenue/Chart Audit team in resolving CDM and charge capture issues. Synchronize CDM data between the CDM and the CDM Workflow & Management Tool on a monthly basis. Import and extract data from various sources to monitor and maintain CDM integrity. Provide ad‑hoc reports based on identified issues. Guide and educate staff to ensure CDM and charge capture standards are followed, including newly acquired entities such as Verdugo Hills. Conduct charge reconciliation activities, research best practices, and deploy charge capture improvement initiatives. Interpret and explain details of charge services as needed. Collaborate with Revenue Cycle and Ancillary teams on education programs for staff regarding charge master and capture processes. Help develop policies and procedures for late charge monitoring and timely capture. Promote professional growth and development within the team. Participate in team, departmental, and organizational goal achievement. Perform other duties as assigned. Required Qualifications Associate’s degree in Business Administration, Accounting, Finance, Healthcare Administration, Nursing, or a related field. Specialized or technical training certification from an accredited program such as Certified Coder (CPC/CCS/COC) or Certificate of Auditing (CPMA) within one year of hire. Minimum five years of experience in the healthcare field, including coding, provider billing, medical records, charge audit, CDM maintenance, Medicare/Medicaid reimbursement, managed care contracts, and patient accounting. Experience with inpatient and outpatient billing (UB‑04) and CMS Medicare reimbursement methodology. Knowledge of government and third‑party payer reimbursement methodologies. Ability to implement a systematic, self‑motivated approach to problem solving and to coordinate resources for plan execution. Proficient skills in MS Office and Windows. Preferred Qualifications Bachelor’s degree in Business Administration, Accounting, Finance, Healthcare Administration, Nursing, or a related field. Previous charged master experience, including CDM maintenance software (Craneware or Med Assets). Experience with hospital charging practices and operations in an acute care setting. Knowledge of revenue cycle flow across hospital billing systems. Working knowledge of CPT, HCPCs, and ICD9 coding principles. Experience with Cerner and Craneware software. Required Licenses & Certifications Certified Coder (CCS or CPC) or Certified Outpatient Coder‑COC (AAPC) or Certified Auditor (CPMA) obtained within one year of hire. Registered Nurse (RN) – CA Board of Registered Nursing (preferred). Pharmacy Technician – CA DCA (preferred). Fire Life Safety Training (LA City) – must obtain within 30 days of hire if not already possessed. Annual base salary range: $99,507.00 – $164,559.00. #J-18808-Ljbffr Veterans in Healthcare