Senior Revenue Integrity Specialist - Clinical Rev Integrity REMOTE

Overview

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

Location:

Alhambra, CA
• Remote:
Fully Remote
• Posted:
Yesterday
• Job requisition

• 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. Serves as SME to meet and/or communicate with various stakeholders for projects that impact revenue integrity and the 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 associated charge flow process.
• Provides CDM data as necessary based on identified issues in ad-hoc reports.
• Provides guidance and education to ensure that CDMs and Charge Capture for existing and newly acquired entities (e.g., Verdugo Hills) follow the standards and policies of Keck Medical Center of USC.
• Performs charge reconciliation activities, industry best practice research, and identifies and deploys charge capture improvement initiatives.
• Interprets and explains details of charges for services provided as needed.
• Participates collaboratively with Revenue Cycle and Ancillary teams in the development, execution, and follow-up of education programs for USC Administration, Managers and Staff on issues related to the charge master, charge capture, and new applications related processes.
• Participates in the development of policies and procedures, monitoring tools for late charges and establishment of procedures for timely and accurate charge capture mechanisms.
• Enhances professional growth and development; actively participates in team development, contributes to dashboards, and works toward team, departmental, and organizational goals and objectives.
• Performs other duties as assigned.

• Associate’s Degree in Business Administration, Accounting, Finance, Healthcare Administration, Nursing, or related field.
• Specialized/technical certification from an accredited program (Certified Coder CPC/ CCS/ COC) or Certificate of Auditing (CPMA) obtained within one year from date of hire.
• 5 years of experience in healthcare; related experience may include clinical service delivery, coding, provider billing, medical records, charge audit, CDM maintenance, Medicare/Medicaid reimbursement, managed care contractual arrangements, and patient accounting.
• Experience with inpatient and outpatient billing requirements (UB-04) and CMS Medicare reimbursement methodology.
• Knowledge of other government and third-party payer reimbursement methodologies.
• Ability to implement a systematic, self-motivated approach to problem solving and coordinate resources to execute plans.
• Proficient skills and knowledge in MS Office/Windows.

• Bachelor’s Degree in Business Administration, Accounting, Finance, Healthcare Administration, Nursing, or related field.
• Experience and knowledge of hospital charging practices.
• Healthcare operations experience,…