Job description

Job Summary:
The Revenue Integrity Specialist serves as the key liaison and subject matter expert for assigned service line areas regarding all aspects of charge capture/charge description master processes.

This position will lead, support, and coordinate on-going charge capture improvement initiatives for assigned service line areas; including charge reconciliation activities, new service implementation, and identification of revenue management opportunities.
The Revenue Integrity Specialist will coordinate all Revenue Integrity activities on behalf of assigned service line areas; department charge capture education, charge audit activities, charge description master management, and monitoring of charge capture related metrics.
This position also has a broad understanding of all areas of the revenue cycle; including Patient Financial Services (PFS), Health Information Management (HIM), and Reimbursement Services.
Assesses efficiency and accuracy of revenue cycle operations for assigned clinical areas
Functions as the Project Manager for revenue cycle process assessments 2x/year (planned)
The assessment includes the areas of registration, charge capture, coding, documentation, billing, reconciliation, payer reimbursement, and compliance.
Uses established project management tools, methodology to conduct revenue cycle assessments.
Identifies project leadership team and members, defines project scope, and develops assessment plans
Conducts assessment activities such as interviews, outcomes analysis, process flows and analysis, documentation reviews, and direct clinical observations as needed.
Identifies quick hits and redesign opportunities for each project.
Communicates regularly with key stakeholders about the progress, critical factors and obstacles related to each revenue cycle assessment.
Assists in developing metrics to be used for ongoing monitoring.
Prepares and presents high quality reports of the revenue cycle department assessment and the findings to various audiences.
Implements quick hit items within the designated time period; Functions as a content expert resource for the redesign activities.
Monitors revenue activity after the process improvement strategies have been implemented.
Works toward meeting institutional goal of increasing revenue through improved charge capture processes.
Performs all required activities to ensure proper and accurate reimbursement.
Conducts third party payer and other externally requested chart/bill audits
Pre-audit will be conducted prior to scheduled audit date 100% of the time.
Schedules audits within 10 days of the audit request 95% of the time.
Completes post audit paperwork and sends these documents to PFS within 3 business days of finalized audit, noting the audit has been completed in EPIC
RIS will give a copy of all the completed audit paperwork to the RI Charge Analyst within 5 business days of the audit being completed.
Communicate significant audit findings to appropriate Department Manager and Senior Finance Partner within 2 weeks of audit completion so corrective actions will be taken as needed.
Maintains knowledge of clinical care, billing, coding compliance rules and other pertinent regulations
Completes 24 hours of continuing education each year
Prepares formal reports and makes formal presentations on revenue cycle assessment findings on a regular basis
Recipients may include clinical staff and department managers, members of Administration, PARC staff, etc.
Demonstrates excellent verbal communication skills.
Demonstrates excellent written communication skills.
Demonstrates expert use of applications such as Word, Excel, and PowerPoint in written reports.
Assists with other projects as necessary
Supports Revenue Analytics Team with month end close.
Contributes to Revenue Analytics providing clinical care and billing guidance for contract negotiations.
Collaborates with Internal Audit and Billing Compliance Departments on clinical department reviews and remediation of any issues.
Collaborates with PFS to help resolve Billing and/or Collection issues

Skills:

Registered nurse or other licensed health care practitioner preferred (PA/NJ licensing preferred).

Coding certification preferred
Clinical expertise in Pediatrics preferred.
Ability to work effectively with all members of the health care team.
Working knowledge of chart/bill audits or ability to abstract medical information.
Strong analytical and organizational skills.
Excellent verbal and written communication skills.
Must be able to work independently.
Strong project management skills.
Will be required to manage multiple complex projects simultaneously.
Effective leadership skills.
Must be detail, action, solution, and results oriented.
Working knowledge of revenue cycle processes.
Computer skills essential.
Will need to use Word, Excel, PowerPoint, and Visio at a minimum.

Education:

Bachelor's degree in clinical program required. Master's degree preferred.
Minimum five (5) years of varied clinical experience as a RN, APN, or other clinical specialist preferred. Pediatric experience preferred.
Working knowledge of coding rules required or willingness to obtain within 3 months of hire.

Experience with billing and documentation systems preferred

Licenses, Certifications, and Registrations

Registered Nurse (Pennsylvania)
Certified Professional Coder (CPC)
American Academy of Professional Coders (AAPC) - Preferred

Revenue Integrity Specialist

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