Revenue Integrity Specialist - Revenue Cycle

Division: Eskenazi Health

Sub-Division: Hospital

Req ID: 26635

Schedule : Full Time

Shift : Days

Eskenazi Health serves as the public hospital division of the Health & Hospital Corporation of Marion County. Physicians provide a comprehensive range of primary and specialty care services at the 333-bed hospital and outpatient facilities both on and off of the Eskenazi Health downtown campus including at a network of Eskenazi Health Center sites located throughout Indianapolis.

FLSA Status

Exempt

Job Role Summary

The Revenue Integrity Auditor is responsible for pre- and post-payment auditing of medical records and associated clinical documentation to ensure proper charge capture, billing in accordance with standard billing policies and reimbursement principles. This position is responsible for assisting Revenue Cycle Services, Health Information Management (HIM), Coding, Clinical Documentation Improvement (CDI), and other departments with resolution of billing issues and/or denials requiring clinical expertise, participating in external audit requests, and special projects as needed. This position also serves as an audit outcome educator with clinical staff in clinic and department settings.

Essential Functions and Responsibilities

• Coordinates, conducts and documents full or partial chart-to-bill audits for:
  • Existing services to ensure revenue capture and documentation accuracy
  • Newly implemented hospital services
  • Defense audits requested by payers or outside agencies
  • Cost outlier and high balance accounts prior to billing or post third party vendor review
  • Other audits as assigned by management
  • Prepares written reports or trending data related to findings and facilitates sign off with leadership
  • Facilitates timely turnaround of audit results
  • Prepares written summaries of departmental audit results, which allow clinical leadership the ability to monitor and manage their revenue capture and documentation processes
  • Keeps Revenue Integrity Supervisor informed on various findings and communications with areas assigned for audit and/or process review
  • Notifies Charge Reconciliation, Charge Description Master (CDM), and Revenue Cycle Education Staff of pertinent audit issues requiring their intervention to remedy or correct
• Works cooperatively within Revenue Cycle Support, and clinic/department leadership to ensure all charges are available within the Electronic Health Record (EHR) on an as-needed basis and according to department standards
• Requests appropriate CDM additions, modifications, deletions and reactivations through the NThrive Workflow Tool
• Develops and maintains a highly effective working relationship with Corporate Compliance, Finance, HIM, Revenue Cycle Services, Transition Support, and various clinic/department staff and their leadership
• Provides education to clinical staff and clinic/department leadership on the appropriate utilization of charges in the Electronic Health Record (EHR) and suggests documentation improvements where appropriate
• Identifies inappropriate billing patterns in accordance with hospital charging protocols and industry standards; makes recommendations for improvement of procedures, documentation, and revenue optimization opportunities
• Works diligently to attain appropriate Revenue Integrity goals
• Researches and resolves EHR billing, payer, and customer service related issues in a timely and compliant manner:
  • Retrieves and validates patient account information and charge-related documentation from multiple information systems and/or from hospital department personnel
  • Researches and resolves charge concerns identified through Charge Capture Audit (CCA) tool
  • Researches and resolves Revenue Guarding Edits that are built to identify accounts with missing charges
  • Validates that charges are on the correct account via EHR Charge Review work queues
  • Resolves National Correct Coding Initiative (NCCI) Edits, Correct Coding Initiative (CCI) Edits, and Medically Unlikely Edits (MUE)
  • Recommends and/or applies appropriate modifiers in support of medical services rendered
  • Researches and corrects Room & Bed and Observation Hour issues
  • Ensures patient satisfaction by resolving charge-related issues routed from Customer Service inquiries
  • Resolves charge issues associated with credit balance accounts
  • Enters account corrections and detailed comments in EHR to ensure a clear line of communication
  • Resolves coding requests that are sent to Revenue Integrity from the Coding department
  • Ensures appropriate revenue direction to ensure charges are accurately reported for financial reports
• Researches, works proactively with charging departments, and resolves billing and/or charging issues; resolves Do Not Bill (DNB) Errors and Warnings

Job Requirements

• Medical Technician, LPN or RN, with current state licensure OR certified R.H.I.A., R.H.I.T., CCS, CCS-P, CPC, CPC-H, CCA, OR Associate's degree required; bachelor's degree preferred
• Experience with Health Information Management (HIM), Facility/Physician Billing, Charge Description Master (CDM), Denials Management, Charge Integrity, Financial Analysis
• Three years of experience in a hospital or physician setting with extensive Revenue Cycle knowledge
• Two years of hospital audit experience with a concentration in High Balance and Cost Outlier and/or facility-based clinic audits

Knowledge, Skills & Abilities

• Requires extensive knowledge of various coding systems, including but not limited to ICD-10-CM, CPT-4, HCPCS, as well as medical terminology, anatomy and physiology, diagnostic and therapeutic tests
• Knowledge of DRG and APC classifications and reimbursement methodologies
• Extensive knowledge of billing processes and payer requirements
• Extensive knowledge of NCCI and CCI requirements for Medicare and Medicaid patients including MUE edits
• Ability to implement or facilitate change utilizing change management techniques
• Excellent oral and written communication skills; must be able to effectively interact and present information with clinical and non-clinical staff
• Excellent customer service and organizational skills; detail- and task-oriented; effectively manages time and workload, and sets appropriate priorities
• Possesses critical thinking and analytical skills
• Ability to work independently and exercise professional judgment to meet daily operational demands
• Ability to work as an effective team member
• Demonstrates team-oriented, professional conduct when resolving issues which cross operational units within Revenue Cycle and/or across Eskenazi Health
• Possesses Microsoft Excel skills including the ability to create and build new worksheets, import and sort data, and use basic formulas
• Possesses Microsoft Word skills to summarize audit outcomes and write internal and external correspondence
• Familiarity with information systems used at Eskenazi Health, including but not be limited to: EPIC, McKesson, NThrive, OnBase, G3, and Careweb preferred

Accredited by The Joint Commission and named as one of Indiana’s best employers by Forbes magazine for two consecutive years and the top hospital in the state for community benefit by the Lown Institute, Eskenazi Health’s programs have received national recognition while also offering new health care opportunities to the local community. As the sponsoring hospital for Indianapolis Emergency Medical Services, the city’s primary EMS provider, Eskenazi Health is also home to the first adult Level I trauma center in Indiana, the first verified adult burn center in Indiana and Sandra Eskenazi Mental Health Center, the first community mental health center in Indiana, just to name a few.