UChicago Medicine · 3 months ago
Revenue Integrity Specialist, Full Time - Days
Chicago, IL
Full-time
Hybrid
Mid Level
$73K/yr - $86K/yrUChicago Medicine is a world-class academic healthcare system, and they are seeking a Revenue Integrity Specialist to support the timely processing of Clinical Labs Part A claims submission. The role involves improving compliant and accurate billing, optimizing reimbursement, and managing regulatory content within the revenue cycle.
Health CareHospitalMedicalMedical Device
Responsibilities
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
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
Audits- Conducts concurrent and retrospective audits of UCMC departments designed to focus on coding, billing, and documentation
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
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
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
Denials- Analyzes top denial trends and implements plans to reduce future denials – including automation, claims edit creation, and education
Qualification
Required
High school diploma required
Proven working knowledge of CPT (Current Procedural Terminology) and ICD (International Classification of Diseases) coding systems required, with auditing experience preferred
Knowledge of Federal billing regulations governing Medicare and Medicaid programs, and working knowledge of other managed care and indemnity (third party) payor requirements
Must possess a working knowledge of Local and National Coverage Determination policies (LCD's and NCD's), Ambulatory Payment Classification (APC) related edits such as the National Correct Coding Initiative (NCCI) and Outpatient Code Editor (OCE), and HIPAA (Health Information Portability & Accountability Act), regulations
Must be proficient in Microsoft Excel, Word, PowerPoint, and have some familiarity with Access
Must be highly analytical, and have excellent written and verbal communication skills
Must possess excellent organizational, time management and multi-tasking skills, along with demonstration of excellent interpersonal skills
Health Information Management or Coding certification required at the time of hire, with the exception of HIA students within three months of hire: RHIA (Registered Health Information Administrator), RHIT (Registered Health Information Technician), CPC (Certified Professional Coder), CCS (Certified Coding Specialist), CCS-P (Certified Coding Specialist Physician), or CCA (Certified Coding Associate)
Preferred
Associate or Bachelor's degree in a health-care information or health care finance related field preferred
Auditing experience preferred
Benefits
Medical and religious exemptions will be considered for flu vaccination consistent with applicable law.
Review the full complement of benefit options for eligible roles at Benefits - UChicago Medicine.
Company
UChicago Medicine
The University of Chicago Medicine has been at the forefront of medicine since 1927, when we cared for our first patients.
Founded in 1927
5001-10000 employees
H1B Sponsorship
UChicago Medicine has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (38)
2024 (31)
2023 (28)
2022 (17)
2021 (23)
2020 (17)
Funding
Current Stage
Late StageTotal Funding
$112.4MKey Investors
National Institutes of Health
2019-04-10Grant· $9M
2018-10-14Grant· $3.4M
2017-05-24Grant· $100M
Leadership Team
Ivan Samstein
Executive Vice President and Chief Financial Officer, University of Chicago Medicine
Jason Keeler
Executive Vice President and COO
Recent News
Chicago Business Journal
2025-03-10
Medical Xpress - latest medical and health news stories
2025-02-01
Investing.com
2024-12-17
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