Senior Revenue Integrity Specialist - Clinical Rev Integrity Exempt

Senior Revenue Integrity Specialist - Clinical Rev Integrity - Full Time 8 Hour Days (Exempt) (Non-Union)

Join to apply for the Senior Revenue Integrity Specialist - Clinical Rev Integrity - Full Time 8 Hour Days (Exempt) (Non-Union) role at Keck Medicine of USC.

As the center of clinical charge capture, the Revenue Integrity (RI) Specialist provides leadership to the daily CDM maintenance workflow between the various entities of Keck Medical Center of USC and monitors the alignment of the various entities to the standard policy for maintaining the CDM. The RI Specialist is responsible for the timely and accurate synchronization of data between the CDM residing in the billing system and CDM management tools.

The Senior RI Specialist shall ensure that the Chargemaster (CDM) is consistent with all coding and billing regulations and accurately represents services provided. This includes ensuring all annual updates required by Medicare and other third‑party payers are up to date. The Senior RI Specialist delivers direction to the documentation of all policies and procedures regarding CDM Maintenance and charge process;

and conducts meetings to evaluate department charge processes to improve charge capture and coding compliance.

The Senior RI Specialist also coordinates with Keck Medical Center of USC Administration, IS, Compliance, Clinical Informatics and Integration personnel on technology projects impacting charge entry, charge dictionaries, and charge, and provides data derived from multiple entities of Keck Medical Center of USC for the management and support of critical decisions and functions related the Chargemaster, CDM Maintenance, and the improvement of charge capture.

As a subject matter expert in the area of compliance and pricing of services, the Senior RI Specialist responds to inquiries regarding Chargemaster issues and is responsible for supervising meetings for projects associated with educating and communicating to clinical revenue generating departmental staff regarding the CDM Maintenance process, coding updates, compliance issues, and charge capture improvement. The Senior RI Specialist works closely with revenue auditors and provides leadership by providing direction to the revenue auditor team to all entities of Keck Medical Center of USC in the research and resolution of requests in a timely manner;

and aid in the training and skill development of auditors to maximize available tools for Chargemaster and billing compliance.

• Performs maintenance to the Keck Medical Center of USC Charge Description Master (Keck & Norris) ensuring all annual updates required by Medicare and other third‑party payers are up to date. Assists the Revenue Cycle in annual coding review and processing of updates.
• Reviews and processes requests for new code additions, code set corrections, revenue code to CPT/HCPCS code mismatch corrections and ongoing identified changes for current systems to maintain compliance with both state and federal regulatory agencies.
• Leads and conducts meetings with Operations Leaders, Revenue Auditors, Clinical Department Staff, and Gatekeepers to address issues involving compliance with government regulations, third‑party payor needs and industry standards.
• Acts as a subject matter expert for projects that impact revenue integrity and CDM.
• Takes the lead and exercises significant judgement and discretion on projects that have a broad, organizational impact.
• Coordinates and provides leadership to Revenue/Chart Audit team associated with research and resolution of account issues related to the CDM, charge capture, and other issues considered to be revenue integrity.
• Synchronizes CDM data between CDM and CDM Workflow & Management Tool for Keck Medical Center of USC entities on a monthly basis.
• Imports/extracts data from various sources and in various formats as needed to review, monitor, track, and maintain the integrity of the CDM and associate charge flow process.
• Provides CDM data as necessary based on identified issues in form of ad‑hoc reports.
• Provides guidance and education to ensure that CDM’s and Charge Capture as needed of exist and newly acquired entities…