Job Description
- 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.
- 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.
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.
- 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.
- Communicates 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.
- Completes 24 hours of continuing education each year
- 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.
- 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
- 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
- Bachelor’s degree in clinical program required. Master’s degree preferred.
- Minimum five (5) clinical experience as a RN, APN, or other related clinical specialist area.
- Previous professional work in a clinical area
- Experience using billing and documentation systems
| Licenses/Certifications | Issuing Agency
|
Time to Obtain
|
Required/
Preferred |
| Registered Nurse (Pennsylvania)
|
Pennsylvania State Licensing Board | upon hire
|
Required |
| Certified Professional Coder (CPC)
|
American Academy of Professional Coders (AAPC)
|
upon hire
|
Preferred
|
Certifications & Licenses:
- Coding certification preferred
- RN
- Registered nurse
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