Veterans in Healthcare · 2 months ago
Revenue Integrity Specialist - Clinical Revenue Integrity - Full Time 8 Hour Days (REMOTE) (Exempt)
United States
Full-time
Remote
Mid Level
$81K/yr - $133K/yr
3+ years expVeterans in Healthcare is seeking a Revenue Integrity Specialist who will be responsible for overseeing the daily CDM maintenance workflow and ensuring compliance with coding and billing regulations. The role involves coordinating with various stakeholders to improve charge capture and providing leadership to the Revenue/Chart Audit team.
Health CareMilitary
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
Participates 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. May lead and conduct meeting as directed
May acts a subject matter expert for projects that impact revenue integrity and CDM. 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 monthly
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 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
Qualification
Required
Associate's degree Business Administration, Accounting, Finance, Healthcare Administration or Nursing
If no Associate's degree, additional 2 years of experience is required
3 years Experience in healthcare field required. Related experience may include a combination of clinical service delivery (nursing or allied health), coding, 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
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)
Preferred
Previous hospital Chargemaster experience, including the use of CDM Maintenance software (Craneware or Med Assets)
Experience and knowledge of Hospital billing and/or charging practices
Healthcare operations experience, particularly in an acute care hospital setting
Current knowledge of the Revenue cycle, specifically the flow of charges in and across hospital billing systems
Working knowledge of CPT, HCPCs and ICD9 coding principles
Skills and knowledge on the following software: Cerner and Craneware
Company
Veterans in Healthcare
Veterans in Healthcare is a comprehensive source of career information and opportunities for military personnel transitioning.
2-10 employees
Funding
Current Stage
Early StageCompany data provided by crunchbase