Revenue Integrity Specialist

Job Summary:
The Revenue Integrity Specialist serves as the key liaison and subject matter expert for assigned service line areas regarding all aspects of charge capture/charge description master processes.

• This position will lead, support, and coordinate on-going charge capture improvement initiatives for assigned service line areas; including charge reconciliation activities, new service implementation, and identification of revenue management opportunities.
• The Revenue Integrity Specialist will coordinate all Revenue Integrity activities on behalf of assigned service line areas; department charge capture education, charge audit activities, charge description master management, and monitoring of charge capture related metrics.
• This position also has a broad understanding of all areas of the revenue cycle; including Patient Financial Services (PFS), Health Information Management (HIM), and Reimbursement Services.
• Assesses efficiency and accuracy of revenue cycle operations for assigned clinical areas
• Functions as the Project Manager for revenue cycle process assessments 2x/year (planned)
• The assessment includes the areas of registration, charge capture, coding, documentation, billing, reconciliation, payer reimbursement, and compliance.
• Uses established project management tools, methodology to conduct revenue cycle assessments.
• Identifies project leadership team and members, defines project scope, and develops assessment plans
• Conducts assessment activities such as interviews, outcomes analysis, process flows and analysis, documentation reviews, and direct clinical observations as needed.
• Identifies quick hits and redesign opportunities for each project.
• Communicates regularly with key stakeholders about the progress, critical factors and obstacles related to each revenue cycle assessment.
• Assists in developing metrics to be used for ongoing monitoring.
• Prepares and presents high quality reports of the revenue cycle department assessment and the findings to various audiences.
• Implements quick hit items within the designated time period; Functions as a content expert resource for the redesign activities.
• Monitors revenue activity after the process improvement strategies have been implemented.
• Works toward meeting institutional goal of increasing revenue through improved charge capture processes.
• Performs all required activities to ensure proper and accurate reimbursement.
• Conducts third party payer and other externally requested chart/bill audits
• Pre-audit will be conducted prior to scheduled audit date 100% of the time.
• Schedules audits within 10 days of the audit request 95% of the time.
• Completes post audit paperwork and sends these documents to PFS within 3 business days of finalized audit, noting the audit has been completed in EPIC
• RIS will give a copy of all the completed audit paperwork to the RI Charge Analyst within 5 business days of the audit being completed.
• Communicate significant audit findings to appropriate Department Manager and Senior Finance Partner within 2 weeks of audit completion so corrective actions will be taken as needed.
• Maintains knowledge of clinical care, billing, coding compliance rules and other pertinent regulations
• Completes 24 hours of continuing education each year
• Prepares formal reports and makes formal presentations on revenue cycle assessment findings on a regular basis
• Recipients may include clinical staff and department managers, members of Administration, PARC staff, etc.
• Demonstrates excellent verbal communication skills.
• Demonstrates excellent written communication skills.
• Demonstrates expert use of applications such as Word, Excel, and PowerPoint in written reports.
• Assists with other projects as necessary
• Supports Revenue Analytics Team with month end close.
• Contributes to Revenue Analytics providing clinical care and billing guidance for contract negotiations.
• Collaborates with Internal Audit and Billing Compliance Departments on clinical department reviews and remediation of any issues.
• Collaborates with PFS to help resolve Billing and/or Collection issues

Skills:

• Registered nurse or other licensed health care practitioner preferred (PA/NJ licensing preferred).

• Coding certification preferred
• Clinical expertise in Pediatrics preferred.
• Ability to work effectively with all members of the health care team.
• Working knowledge of chart/bill audits or ability to abstract medical information.
• Strong analytical and organizational skills.
• Excellent verbal and written communication skills.
• Must be able to work independently.
• Strong project management skills.
• Will be required to manage multiple complex projects simultaneously.
• Effective leadership skills.
• Must be detail, action, solution, and results oriented.
• Working knowledge of revenue cycle processes.
• Computer skills essential.
• Will need to use Word, Excel, PowerPoint, and Visio at a minimum.

Education:

• Bachelor's degree in clinical program required. Master's degree preferred.
• Minimum five (5) years of varied clinical experience as a RN, APN, or other clinical specialist preferred. Pediatric experience preferred.
• Working knowledge of coding rules required or willingness to obtain within 3 months of hire.

• Experience with billing and documentation systems preferred

Licenses, Certifications, and Registrations

• Registered Nurse (Pennsylvania)
• Certified Professional Coder (CPC)
• American Academy of Professional Coders (AAPC) - Preferred