Senior Revenue Integrity Specialist - Clinical Rev Integrity - Full Time 8 Hour Days (Exempt) ([...]

Job Summary As the center of clinical charge capture, the Revenue Integrity (RI) Specialist is responsible for leading the daily CDM maintenance workflow across Keck Medical Center of USC, ensuring alignment with standard policy and regulatory requirements. The role ensures timely and accurate synchronization of CDM data between the billing system and CDM management tools, oversees coding and billing standards, coordinates with administration, IS, compliance, and clinical informatics, and provides data-driven insights to support management decisions regarding charge capture and pricing. Essential Duties Maintain the Keck Medical Center of USC Charge Description Master, ensuring all annual updates for Medicare and third‑party payers are current. Assist the Revenue Cycle with annual coding reviews and processing of updates. Review and process requests for new code additions, code set corrections, and mismatches between revenue codes and CPT/HCPCS codes. Lead meetings with Operations Leaders, Revenue Auditors, Clinical Department Staff, and Gatekeepers to address compliance and industry standard issues. Act as a subject‑matter expert on projects impacting revenue integrity and the CDM. Provide leadership to the Revenue/Chart Audit team in resolving account issues related to the CDM and charge capture. Synchronize CDM data monthly across all Keck Medical Center of USC entities, importing and extracting data as needed. Generate and provide ad‑hoc reports on CDM data to support decision‑making. Guide and educate staff on CDM standards, including new entity onboarding. Perform charge reconciliation, conduct best‑practice research, and deploy charge capture improvement initiatives. Collaborate with the Revenue Cycle and Ancillary team to develop education programs on charge master and capture processes. Assist in developing policies, monitoring tools, and procedures for timely and accurate charge capture. Participate in team development, contribute to dashboards, and support organizational objectives. Perform other duties as assigned. Required Qualifications Associate’s Degree in Business Administration, Accounting, Finance, Healthcare Administration, Nursing, or a related field. Certification from an accredited program (Certified Coder CPC/CCS/COC or Cert of Auditing CPMA) obtained within one year of hire. 5+ years of experience in healthcare, covering clinical service delivery, coding, provider billing, medical records, charge audit, CDM maintenance, Medicare/Medicaid reimbursement, managed care contracts, 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 methodologies. Ability to implement a systematic, self‑motivated problem‑solving approach and coordinate resources to execute plans. Proficient skills in MS Office/Windows. Preferred Qualifications Bachelor’s Degree in Business Administration, Accounting, Finance, Healthcare Administration, Nursing, or a related field. Previous hospital Charge Master experience, including use of CDM Maintenance software (Craneware or Med Assets). Experience and knowledge of hospital charging practices. Healthcare operations experience, especially in an acute care hospital setting. Knowledge of the revenue cycle and charge flow across hospital billing systems. Working knowledge of CPT, HCPCS, and ICD‑9 coding principles. Experience with Cerner and Craneware software. Required Licenses / Certifications Certified Coder (CCS or CPC), Certified Outpatient Coder – COC, 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); if no card upon hire, one must be obtained within 30 days and maintained by renewal. Benefits Annual base salary range: $99,507.00 – $164,559.00. Equal Opportunity Employment USC is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status, disability, or any other characteristic protected by law or USC policy. USC observes affirmative action obligations consistent with state and federal law. Non‑Discrimination Statement Applicant and employee information gathered by USC will be used for employment and other purposes in accordance with all applicable laws, regulations, policies, and procedures. USC offers reasonable accommodations for applicants and employees with disabilities. #J-18808-Ljbffr University of Southern California