Revenue Integrity Specialist-(Audits & Denials) Revenue Integrity-Corporate 42nd Street- Full-T[...]

Description Job Description Revenue Integrity Specialist-(Audits & Denials) Revenue Integrity-Corporate 42nd Street- Full-Time- Days- Hybrid The Revenue Integrity Specialist for the Mount Sinai Health System (MSHS) and the Icahn School of Medicine at Mount Sinai (ISMMS) focuses on optimizing charge capture, reconciliation and process improvement for hospital‑based revenue producing departments and the ambulatory sites. By fostering strong, collaborative relationships across the organization, this role will promote financial stewardship and facilitate bidirectional communication with clinical departments, providers, and key stakeholders. The Revenue Integrity Specialist will leverage their expertise in clinical workflows, revenue cycle management, and Epic to proactively identify and execute process improvements that enhance the system’s financial health. This position reports to the Senior Manager of Revenue Integrity. The position requires the consistent exercise of independent professional judgment in interpreting, applying, and operationalizing complex clinical, regulatory, and reimbursement frameworks impacting revenue integrity. Responsibilities Charge Capture and Revenue Accuracy Ensure accurate charge capture, reconciliation, and compliance for all facility and professional services for designated service line. Subject matter authority responsible for interpreting and applying charge methodology for services within designated service line. Monitor charge baselines to identify variances, analyze causes of charge lag, and collaborate with key stakeholders to implement workflow improvements to reduce late charges. Subject matter authority and expert for the Charge Description Master (CDM/EAP), performing professional‑level quality review and validation of additions, deletions, and revisions and ensuring compliant charge code structures are available for all services within designated area. Compliance and Auditing Conduct independent revenue integrity analyses of clinical documentation and billing outputs, requiring interpretation of coding, reimbursement, and payer rules. Perform chart‑to‑bill audits to ensure accurate charge, price, and quantity, mitigating risks and ensuring compliance. Analyze physician and service line charges to ensure compliance with payer regulations, methodologies, and managed care contracts. Coordinate special focus reviews, collaborating with compliance, patient access, and clinical departments. Mitigate the risk of compliance violations, audits, and potential penalties related to charging errors. Ensure compliance with all HIPAA privacy and security standards. Process Optimization Independently design, evaluate, and ensure implementation of revenue integrity workflows and controls, requiring application of professional judgment. Develop, refine, and implement efficient processes and controls to optimize revenue integrity. Collaborate with HIM, billing, IT, and clinical stakeholders to align workflows, resolve billing issues, and manage Epic work queues. Exercise independent professional judgment to develop and refine the processes necessary to complete the work along with the ability to organize people and activities. Education & Stakeholder Collaboration Provide interpretive guidance to clinical departments on reimbursement policy, coding updates, and charge capture requirements based on professional expertise. Educate clinical departments on CPT updates, EAP changes, and new/expanded services. Provide education to designated service lines on quarterly and end‑of‑year CPT updates and communicate any EAP updates or changes. Establish and maintain strong working relationships with revenue cycle leaders, clinical leaders and staff, other key stakeholders, and foster a strong partnership with key strategic partners. Perform other duties as assigned. Qualifications Bachelor’s degree in public health/administration, finance, business or a related field (clinical degree, RN, PT, OT, RT etc.) or equivalent education and experience. 3–5 years working in a healthcare provider organization clinical department and/or 1–2 years working in a healthcare provider organization clinical department with 2 plus years experience in healthcare revenue cycle, revenue integrity, HIM or finance. Hospital and/or professional charge experience. Epic experience preferred. Experience in one of the following areas: Pharmacy, Hematology–Oncology, Laboratory and Pathology, Faculty Practices, Cardiology, Imaging, Rehabilitation or hospital‑based services. Coding certification is a plus. Non‑Bargaining Unit, 506 – Chargemaster/Projects – MSH, Mount Sinai Hospital Compensation The Mount Sinai Health System provides salary ranges that comply with the New York City Law on Salary Transparency in Job Advertisements. The salary range for the role is $79,720 – $119,580 annually. Actual salaries depend on a variety of factors, including experience, education, and operational need. The salary range or contractual rate listed does not include bonuses, incentive, differential pay or other forms of compensation or benefits. Equal Opportunity Employer The Mount Sinai Health System is an equal opportunity employer, complying with all applicable federal civil rights laws. We do not discriminate, exclude, or treat individuals differently based on race, color, national origin, age, religion, disability, sex, sexual orientation, gender, veteran status, or any other characteristic protected by law. We are deeply committed to fostering an environment where all faculty, staff, students, trainees, patients, visitors, and the communities we serve feel respected and supported. Our goal is to create a healthcare and learning institution that actively works to remove barriers, address challenges, and promote fairness in all aspects of our organization. #J-18808-Ljbffr Mount Sinai Morningside