Revenue Integrity Specialist, Lab Administration - Full-Time, Day Shift

Job Description Be a part of a world-class academic healthcare system, UChicago Medicine, as a Revenue Integrity Specialist in the Laboratory Administration department. Here, you will ensure accurate, compliant billing and charge capture, optimize reimbursement, reduce errors and audit risk, and support departments in maintaining efficient, compliant revenue cycle processes. This is the Laboratory Administration department. This position will be primarily a work from home opportunity with the requirement to come onsite as needed. You will need to be based in the greater Chicagoland area. The Revenue Integrity Specialist ensures accurate, compliant billing and charge capture at the point of service to reduce rework and improve cash flow. This role promotes best practices in coding, billing, and documentation while partnering with departments to optimize reimbursement and resolve errors that could delay or deny claims. It also monitors revenue activity, mitigates audit risk through education and audits, and supports operational efficiency to maximize revenue in a complex regulatory environment. Essential Job Functions Reviews revenue performance of UCMC departments at the cost center and charge line-item level, monitoring charge capture volume in units and dollars posted. Identifies significant declines in revenue, analyzes patterns, performs sample audits, identifies revenue risk, and notifies appropriate departments and administrators of issues. Performs close revenue monitoring following events that could impact the hospital revenue cycle including implementation of Electronic Medical Record software modules or the opening of new facilities, units, or outpatient clinics. Participates in workgroups to implement process improvements which reduce claims delays and denials. Establishes Revenue Cycle and Billing Policies. Use software such as Revenue Guardian to help identify revenue opportunities. Complete process improvement to identify issues in the revenue cycle and improve revenue cycle processes from first time billing to denials management. Reviews charge capture processes to identify revenue opportunities or risk for the hospital. Assists in developing new business procedures in order to optimize reimbursement levels. Provides guidance and/or assistance in the correction and prevention of Claim Edits that prevent compliant, timely, and accurate transmittal of claims for UCMC departments. Local Medical Review Policy (LMRP) edits require the review of clinical documentation against payor specific Medical Necessity guidelines such as LCD’s (Local Coverage Determination) and NCD’s (National Coverage Determination) with the review and coding of conditions and symptoms found in the Medical Record and via Physician Query to resolve the edit. APC (Ambulatory Payment Classifications) edits require the review of NCCI (National Correct Coding Initiative), OCE (Outpatient Code Editor), and MUE (Medically Unlikely Edits) requiring addition of payment modifiers to resolve the edit. HIPAA (Health Information Portability and Accountability Act) edits require the review of patient clinical or administrative data with the addition of condition and occurrence codes to resolve the edit. During course of resolution of all edits, identifies improper billing and coding including duplication of charges, incorrect procedure billing such as under coding, up coding, wrong CPT (Current Procedural Terminology) code, or wrong number of units. Recommends changes to CPT procedures or diagnosis codes per coding guidelines. All charges inappropriate to bill require write-off decisions. Advises departments on resolution of charge disputes initiated by patients requiring review of documentation for appropriate coding and billing and recommends resolution. Monitors bill hold patterns in high volume, high dollar, or problem prone clinics with feedback and recommendations regarding process or workflow changes. Conducts concurrent and retrospective audits of UCMC departments designed to focus on coding, billing, and documentation. Includes audits as directed by the Office of Medical Center Compliance Committee, and/or audits related to Office of Inspector General (OIG) Workplan items, Pre-Billing & Retrospective audits (i.e. Correct Coding, Facility E/M, Infusion Coding), Claims Resolution Audits, RAC audits, Modifier Audits, Charge Capture Audits, and other audits as needed or requested, Outpatient or Inpatient. Communicates findings back to department with re‑audit and education as needed based on findings. Identify regulatory changes that impact UCMC departments who provide the service in question in order to reduce compliance risk for improper billing, as well as maximize revenue when there are new CPT or HCPCS codes available, changes in payment rates, or other considerations. Uses Chargemaster searches for identification of impacted departments, with written communication to said departments. Includes review of Outpatient Prospective Payment System Proposed and Final rules, monthly Medicare Part A & B Medical Review Policy Updates, CMS Transmittals, Medlearn Matters, State and Third-Party Payor regulations, Medicare Recovery Audit Contractors, and other such bodies and regulations that include information that impact the revenue cycle of the hospital. Assists in developing new business procedures as needed in response to regulation changes. Identifies need for education and develops and conducts education tailored to needs of UCM departments such as infusion coding training, training on billing for new service lines, Global Period billing. Education to managers and frontline staff regarding front end processes that affect the revenue cycle downstream such as Late Charges, ABN (Advance Beneficiary Notice) check compliance, and general revenue cycle training. Conducts standing bi‑monthly educational sessions for Billers, Coordinators, RNs, and other staff which earn annual Compliance Credit regarding regulatory compliance, coding, and billing topics. Also, educates physicians on medical necessity requirements and best documentation practices to support said services. Serves as a resource to the Faculty, Clinic Coordinators, and Department Staff on Medical Necessity matters, how to bill for new services, and other billing compliance matters. Creates, updates, and maintains educational revenue cycle materials on compliant coding and billing. Regularly communicates with front end about revenue cycle matters, formally or informally. Advisement to new units, clinics, or acquisitions on revenue cycle billing matters to maximize revenue and bill compliantly. Analyzes top denial trends and implements plans to reduce future denials – including automation, claims edit creation, and education. Helps create template letters for common, recurring denials. As directed, works with clinical departments as a liaison to assist in reverse denials. Performs other duties as assigned. Required Qualifications High school diploma required. Proven working knowledge of CPT (Current Procedural Terminology) and ICD (International Classification of Diseases) coding systems required. Knowledge of Federal billing regulations governing Medicare and Medicaid programs and working knowledge of other managed care and indemnity (third party) payor requirements. Must possess a working knowledge of Local and National Coverage Determination policies (LCD’s and NCD’s), Ambulatory Payment Classification (APC) related edits such as the National Correct Coding Initiative (NCCI) and Outpatient Code Editor (OCE), and HIPAA (Health Information Portability & Accountability Act), regulations. Must be proficient in Microsoft Excel, Word, PowerPoint, and have some familiarity with Access. Must be highly analytical, and have excellent written and verbal communication skills. Must possess excellent organizational, time management and multi-tasking skills, along with demonstration of excellent interpersonal skills. Preferred Qualifications Associate or Bachelor’s degree in a health‑care information or health care finance related field preferred. Auditing experience preferred. Licenses/Certifications Health Information Management or Coding certification required within three months of hire: RHIA (Registered Health Information Administrator) RHIT (Registered Health Information Technician) CPC (Certified Professional Coder) CCS (Certified Coding Specialist) CCS-P (Certified Coding Specialist Physician) CCA (Certified Coding Associate) Position Details Job Type/FTE: Full-Time (1.00) Shift: Day Shift, 8:30am – 5:00pm Work Location: Remote Unit/Department: Laboratory Administration CBA code: Non-Union 5815 S Maryland Ave Compensation & Benefits Overview UChicago Medicine is committed to transparency in compensation and benefits. The pay range provided reflects the anticipated wage or salary reasonably expected to be offered for the position. The pay range is based on a full-time equivalent (1.0 FTE) and is reflective of current market data, reviewed on an annual basis. Compensation offered at the time of hire will vary based on candidate qualifications and experience and organizational considerations, such as internal equity. Pay ranges for employees subject to Collective Bargaining Agreements are negotiated by the medical center and their respective union. Review the full complement of benefit options for eligible roles at Benefits - UChicago Medicine. Equal Opportunity Statement UChicago Medicine is an equal opportunity employer. We evaluate qualified applicants without regard to race, color, ethnicity, ancestry, sex, sexual orientation, gender identity, marital status, civil union status, parental status, religion, national origin, age, disability, veteran status and other legally protected characteristics. Employment Conditions As a condition of employment, all employees are required to complete a pre-employment physical, background check, drug screening, and comply with the flu vaccination requirements prior to hire. Medical and religious exemptions will be considered for flu vaccination consistent with applicable law. #J-18808-Ljbffr UChicago Medicine