Revenue Integrity Specialist, Days

Job Description

Be a part of a world-class academic healthcare system, Uchicago Medicine, as a Revenue Integrity Specialist in the Lab Administration department. This position will be primarily a work from home opportunity with the requirement to come onsite as needed. You may be based outside of the greater Chicagoland area. 

This role supports timely processing of all (~4.9M billables) Clinical Labs Part A claims submission and resolves problems with denied claims. The Lab Administrative department is crucial for maintaining all key billing and auditing needs of the reference laboratories. We provide reference laboratory testing to various related and unrelated health care entities, managed care organizations and non-affiliated hospitals, outpatient clinics and private physicians' offices.   

 In this role, the Revenue Integrity Specialist will improve compliant and accurate billing, and charge capture at the point of service at UChicago Medicine's (UCM) revenue cycle; to decrease costly back-end work and improve cash flow.  

• Implement and promote consistent revenue integrity practices in regards to compliance in coding, billing, and proper documentation
• Optimize reimbursement working in partnership with departments to further develop the revenue stream and documentation processes
• Analyzes and assists with correction of billing and coding errors identified by internal and vendor generated pre-billing edits designed to prevent claims delays & denials and non-compliant billing practices
• Mitigate external audit risks via the practice of audits and continual educational efforts
• Monitor detailed revenue volumes, Claim Edits, and late charges for the hospital, and provide real time notification to unusual variances
• Advises regarding proper revenue cycle processes and workflows
• Assists or advises departments regarding resolution of errors that prevent timely, accurate, and compliant claims submittal
• Manage regulatory content, simplifying the complex reimbursement environment through promotion and support of consistent operational efficiencies.
• Help departments to maximize revenue when CPT (Current Procedural Technology) codes for new technologies and services, or change in the payment rates for these and other established services occur

Essential Job Functions 

• Claims Edit Monitoring and Resolution- Provides guidance and/or assistance in the correction and prevention of billholds that prevent compliant, timely, and accurate transmittal of claims edits for UCM departments. 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. Advises departments on resolution of charge disputes initiated by patients requiring review of documentation for appropriate coding and billing and recommends resolution.
• Audits- 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) Work plan 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 off findings.
• Revenue Integrity- Reviews revenue performance of UCM departments at the cost center and charge line item level, monitoring charge capture volume in units and dollars posted. Uses 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.
• Regulatory Review- Identify regulatory changes that impact UCM 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. Assists in developing new business procedures as needed in response to regulation changes.
• Education & Training- 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. 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.
• Denials- 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.

Required Qualifications 

• High school diploma required
• Associate or Bachelor’s degree in a health-care information or health care finance related field preferred
• Proven working knowledge of CPT (Current Procedural Terminology) and ICD (International Classification of Diseases) coding systems required, with auditing experience preferred
• 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 

Licenses and Certifications

• Health Information Management or Coding certification required at the time of hire, with the exception of HIA students within three months of hire:

o   RHIA (Registered Health Information Administrator),

o   RHIT (Registered Health Information Technician),

o   CPC (Certified Professional Coder),

o   CCS (Certified Coding Specialist),

o   CCS-P (Certified Coding Specialist Physician), or

o   CCA (Certified Coding Associate)

Position Details 

• Job Type/FTE: 1.00 FTE 
• Shift: Days Monday-Friday (No Weekends) 8am-4:30pm (Flexible start time)
• Unit/Department: Lab Administration  
• CBA Code: Non-Union

Why Join Us

We’ve been at the forefront of medicine since 1899. We provide superior healthcare with compassion, always mindful that each patient is a person, an individual. To accomplish this, we need employees with passion, talent and commitment… with patients and with each other. We’re in this together: working to advance medical innovation, serve the health needs of the community, and move our collective knowledge forward. If you’d like to add enriching human life to your profile, UChicago Medicine is for you. Here at the forefront, we’re doing work that really matters. Join us. Bring your passion.

UChicago Medicine is growing; discover how you can be a part of this pursuit of excellence at: UChicago Medicine Career Opportunities

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.

Must comply with UChicago Medicine’s COVID-19 Vaccination requirement as a condition of employment. If you have already received the vaccination, you must provide proof as part of the pre-employment process. This is in addition to your compliance with the Flu Vaccination requirement as well. Medical and religious exemptions will be considered consistent with applicable law. Lastly, a pre-employment physical, drug screening, and background check are also required for all employees prior to hire.

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.