GENERAL SUMMARY:
The Revenue Integrity Specialist position identifies revenue opportunities and works collaboratively with Revenue Cycle staff to drive process improvement, educate clinical departmental staff, and document workflows. Primary areas of focus include increased revenue capture, compliance, and decreased denials.
PRINCIPLE DUTIES AND RESPONSIBILITIES:
1. Actively participates in team development, achieving financial targets, and accomplishing department goals and objectives.
2. Analyzes charge reconciliation reports to verify that departments have captured all charges, and compile findings in departmental charge capture performance reports.
3. Identifies charge trends and utilizes this information to determine quarterly focused reviews of specific departments.
4. Provides additional education determined by findings.
5. Coordinates with the RI Auditor to review provider/clinician documentation to verify that the medical record supports the charges billed, prepares a summary report of findings, and shares with departmental leadership.
6. Coordinates with RI Auditor to review accounts comparing the medical record and itemized bill to identify charging and billing weaknesses in the system.
7. Coordinates with CDM Manager regarding Medicare and other regulatory updates to provide education to departments and update CDM accordingly.
8. Works with CBO (Denials, Billing and third Party) to identify issues related to denied charges for hospital services, and coordinates with CDM Manager to update CDM accordingly.
9. Meets with clinical departments and specialties to ensure appropriate charge capture for services provided.
10.Serves as a regulatory resource of Medicare, Medicaid, Medicaid OPPS reimbursement and other third-party billing rules and coverage through self-directed education and communication to departments.
11.Performs other duties as assigned.
EDUCATION/EXPERIENCE REQUIRED:

• Bachelor's Degree in healthcare, business, or related field, or ten (10) or more years of clinical or healthcare revenue cycle experience required.
• Knowledge of Medicare, Medicaid, Medicaid OPPS reimbursement, and other third-party billing rules/coverage.
• General understanding of the hospital revenue cycle.
• Excellent written, organizational, analytical, motivational, and critical thinking skills.
• EPIC experience, preferred. Hospital billing and finance background, preferred.

CERTIFICATIONS/LICENSURES REQUIRED:

• Coding Credential (CPC, COC, CCA, CCS, RHIT) or Clinical Credential (RN, NP, PA) required.