Senior Revenue Integrity Specialist - Clinical Rev Integrity REMOTE

Responsibilities

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 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 ensures 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 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 to the Chargemaster, CDM maintenance, and the improvement of charge capture.

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

• Associate’s Degree in Business Administration, Accounting, Finance, Healthcare Administration, Nursing, or a related field.
• Specialized/technical training certification from an accredited program of Certified Coder (CPC/CCS/COC) or Certificate of Auditing (CPMA) within one year from date of hire.
• 5 years of experience in the healthcare field, including clinical service delivery, coding, provider billing, medical records, charge audit environment, 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 methodology.
• Ability to implement a systematic, self‑motivated approach to problem solving and identify, coordinate, and optimize resources to execute plans.
• Proficient skills and knowledge in MS Office and Windows.

• Bachelor’s Degree in Business Administration, Accounting, Finance, Healthcare Administration, Nursing, or a related field.
• Experience and knowledge of hospital charging practices.
• Healthcare operations experience, particularly in an acute care hospital setting.
• Current knowledge of the revenue cycle and the flow of charges in and across hospital billing systems.
• Previous hospital Chargemaster experience, including the use of CDM Maintenance software (Craneware or Med Assets).
• Working knowledge of CPT, HCPCs and ICD‑9 coding principles.
• Skills and knowledge on the following software:
  Cerner and Craneware.
• Registered Nurse (RN) (CA Board of Registered Nursing).
• Pharmacy Technician (CA DCA).

• Specialty certification:
  Certified Coder (CCS or CPC), Certified Outpatient Coder‑COC (AAPC) or Certified Auditor (CPMA) obtained within one year of date of hire.
• Fire Life Safety Training (LA City). If no card upon hire, one must be obtained within 30 days of hire and maintained by renewal before expiration date (Required within LA City only).

The annual base salary range for this position is $95,680.00 – $.

USC is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status, disability, or any other characteristic protected by law or USC policy. USC observes affirmative action obligations consistent with state and federal law. USC will consider for employment all qualified applicants with criminal records in a manner consistent with applicable laws and regulations, including the Los Angeles County Fair Chance Ordinance for employers and the Fair Chance Initiative for Hiring Ordinance, and with due consideration for patient and student safety.

We provide reasonable accommodations to applicants and employees with disabilities. Applicants with questions about access or requiring a reasonable accommodation for any part of the application or hiring process should contact USC Human Resources.