Apply on Employer Site

Keck Medicine of USC · 3 hours ago

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

United States

Full-time

Remote

Senior Level

$96K/yr - $158K/yr

5+ years exp

Keck Medicine of USC is seeking a Senior Revenue Integrity Specialist to lead the clinical charge capture process. This role involves maintaining the Charge Description Master (CDM), ensuring compliance with billing regulations, and providing guidance on charge capture improvement initiatives.

Health CareHospitalService IndustryWellness

Responsibilities

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 process requests for new code additions, code set corrections, revenue code to CPT/HCPCS code mismatch corrections and on-going 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 a subject matter expert for projects that impact revenue integrity and CDM. Subject matter expert to meet and/or communicate with various stakeholders for projects that impacts 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 associate charge flow process

Provides CDM data as necessary based on identified issues in form of ad-hoc reports

Provides guidance and education to ensure that CDM’s and Charge Capture as needed of exist and newly acquired entities (i.e. 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 on details of charge services provided as needed

Participates collaboratively with Revenue Cycle and Ancillary team in the development, execution, and follow-up of education programs for USC Administration, Managers and Staff on all 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 in accomplishing team, departmental, and organizational goals and objectives

Performs other duties as assigned

Qualification

Certified Coder (CPC/CCS/COC)Charge Description Master (CDM)Healthcare billing experienceMedicare reimbursement methodologyMS Office proficiencyCPTHCPCsICD9 codingHospital charging practicesTeam developmentProblem solvingCommunication skills

Required

Associate's Degree Business Administration, Accounting, Finance, Healthcare Administration, Nursing, or similar/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 Experience in healthcare field required. Related experience may include a combination of clinical service delivery (nursing or allied health), 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 required

Must be able to implement a systematic, self-motivated approach to problem solving and be able to identify, coordinate and optimize resources needed to execute plan

Proficient skills and knowledge in MS Office/ Windows

Specialty Certification Certified Coder (CCS or CPC), Certified Outpatient Coder-COC (AAPC) or Certified Auditor (CPMA) obtained within one (1) 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)