Revenue Integrity Specialist; oncology

Job Description

Be a part of a world-class academic healthcare system,
Uchicago Medicine
, as a Revenue Integrity Specialist in the Revenue Cycle 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.

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. The specialist will lead regularly scheduled meetings to collaborate with clinical staff, service line leadership, and coding teams, I.T. and other revenue cycle departments to proactively resolve revenue issues to optimize reimbursement.

Strong written and oral communication skills and organizational skills is essential to be successful in this role. Any candidate must possess a strong understanding of hospital billing, compliance standards, and reimbursement methodologies (including DRG/APC). A strong, working knowledge of oncology and/or allied health services (genetic counseling, dieticians, social workers, etc.) is preferred.

• 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…