Apply on Employer Site

Children's Hospital of Philadelphia · 16 hours ago

Revenue Integrity Specialist

Philadelphia, PA

Full-time

Hybrid

Senior Level

$99K/yr - $126K/yr

5+ years exp

Children’s Hospital of Philadelphia (CHOP) is a leading pediatric healthcare provider offering innovative care. The Revenue Integrity Specialist plays a key role in ensuring accurate charge capture and reimbursement across the revenue cycle, collaborating with various departments to improve processes and optimize financial outcomes.

Child CareHealth CareHospitalMedicalNon Profit

Growth Opportunities

Responsibilities

Ensures optimal revenue recognition for all hospital departments and hospital owned physician practices

Manages on-going charge capture improvement initiatives

Conducts quarterly on-site meetings with assigned service line clinical departments to ensure accurate charge capture practices and workflows are in place; review a) RI charge capture-charge reconciliation policy, b) departments' charge entry-charge reconciliation policy and c)the RI Check-in checklist at each meeting

Monitors gross revenue performance against budget and assists in root cause analysis and mitigation of discovered findings

Acts as the charge capture subject matter expert and primary contact for assigned clinical areas

Regularly reviews and updates charge capture related policies and procedures for assigned clinical areas

Makes suggestions, initiates discussion of any applicable process improvements

Collaborates with the Revenue Integrity CDM Specialists to support ongoing CDM updates, preference list maintenance, or charge interfaces impacting charging mechanisms

Facilitates charge capture related functions for new cost center or new department creation

Coordinates system related upgrades or application updates between assigned clinical areas and Information Technology Department

Provides timely educational intervention to assigned clinical areas in support of charge capture processes

Develops educational materials (i.e. Word, PowerPoint) for assigned clinical area to use for training purposes as needed

Monitors department work queues (i.e. Charge Review) of assigned areas and provides assistance to resolve WQ issues when needed to facilitate timely WQ resolution

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

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

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

Qualification

Revenue cycle processesCharge capture improvementClinical experienceCoding rules knowledgeProject managementAnalytical skillsComputer skillsSolution-orientedWord proficiencyExcel proficiencyPowerPoint proficiencyVisio proficiencyOrganizational skillsVerbal communicationWritten communicationLeadership skillsDetail-orientedResults-oriented

Required

Bachelor's Degree Clinical Program Required

At least five (5) years Clinical experience as a RN, NP/APN, RT or other related clinical specialist area Required

Previous professional work in a clinical area Required

Registered Nurse (Pennsylvania) - Pennsylvania State Licensing Board - upon hire - Required or

Respiratory Therapist (Pennsylvania) - Pennsylvania State Licensing Board - upon hire - Required

Working knowledge of coding rules

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

Effective leadership skills

Will be required to manage multiple complex projects simultaneously

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

Preferred

Master's Degree Preferred

Experience using billing and documentation systems Preferred

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

Benefits

Fair and transparent pay practices

Factors such as skills and experience could result in an offer above the salary range noted in this job posting

Company

Children's Hospital of Philadelphia

Glassdoor4.0

Since its start in 1855 as the nation's first hospital devoted exclusively to caring for children, The Children's Hospital of Philadelphia has been the birthplace for many dramatic firsts in pediatric medicine.

Founded in 1855

Philadelphia, Pennsylvania, USA

10001+ employees