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Revenue Integrity Specialist

4 months ago

Duarte, United States City of Hope Full time

Join the transformative team at City of Hope, where we're changing lives and making a real difference in the fight against cancer, diabetes, and other life-threatening illnesses. City of Hope's growing national system includes its Los Angeles campus, a network of clinical care locations across Southern California, a new cancer center in Orange County, California, and treatment facilities in Atlanta, Chicago and Phoenix. our dedicated and compassionate employees are driven by a common mission: To deliver the cures of tomorrow to the people who need them today.

This role serves as a charge capture/charge description master expert to clinical service line leaders and ensures processes are in compliance with Federal/State guidelines. This position identifies revenue opportunities and works collaboratively with Revenue Cycle staff to develop a work plan to ensure process improvement is understood by departmental managers and staff and is documented throughout the revenue cycle with the expected outcome being increased revenue capture and decreased denials.

Another objective of the Revenue Integrity Specialist is to analyze charge transactions along with Research documentation to properly bill Research sponsors for protocol related services provided to the patient. The Revenue Integrity Specialist also serves as a patient advocate and promotes customer satisfaction by appropriately explaining and resolving charge discrepancies. The Revenue Integrity Specialist participates in departmental and organizational performance improvement activities and appropriately communicates audit findings.

As a successful candidate, you will:

* Analyzes charge transactions along with Research documentation to properly bill Research sponsors for protocol related services provided to the patient
* Can analyze and interpret research study budgets
* Can analyze the protocol for missing charges on the budget. Verifies medical procedure documentation and completeness of the Medical Record. Requests documentation as needed to support charges.
* Coordinates/conducts entrance and exit audit interviews with third party payers in relation to patient bills. Recommends to management the appropriate actions and strategies to be taken.
* Reviews medical records for appropriate documentation to appeal proposed clinical and technical denials
* Conducts special patient charge studies for various departments. Develops data and provides interpretation of intangible or unusual factors and summarizes findings appropriately.
* Maintains a record of audit account activity and takes appropriate follow-up actions.
* Interprets and explains to patients or family members the details of medical services provided, if requested.
* Conducts department in-service training on an as needed basis.
* Serves as charge capture/charge description master expert to clinical service line leaders for all areas.
* Monitoring on specific clinical service lines to ensure best practices. Champions standardization of charge capture process, and ensures appropriate discipline-specific charge capture as it relates to government and commercial payer requirements.
* Performs charge reconciliation activities, industry best practice research, and identifies and deploys charge capture improvement initiatives.
* Ensures charge capture revenue management opportunities are identified and service line specific reimbursement and revenue management is reviewed and monitored.
* Coordinates with CDM Analyst, Billers, and Auditors to identify revenue management opportunities, conducts charge reconciliation to ensure optimal charge capture, and reviews and monitors service line specific information regarding hospital services, reimbursement, and revenue management
* Conducts routine on-site meetings with clinical staff and all hospital departments to ensure all charges are being captured and reported accurately using the correct charging methodology
* Identifies system-wide best practices by specialty and works with all affiliates to establish best practices in that specialty throughout City of Hope
* Collaborates with the Denial Management team, Auditors and Billing ream in order to contribute to resolving claims issues
* Stays current with government and commercial payer billing and charging regulations/requirements and industry charge capture best practices
* Participates in charging and billing decisions/interpretations at the department and system-wide level and ensures proper documentation for all services rendered by the department
* Assist with review and perform manual charge entry/correction as needed.
* Participates collaboratively with Revenue Cycle team in the development, execution and follow-up of education programs for City of Hope Administration, Managers and Staff on all issues related to the charge master and charge capture related processes.
* Collaborates with Denial Management team, Compliance, and other departments to prepare and deliver educational materials regarding accurate charging, billing and documentation for customers
* Participates in special projects as assigned
* Enhances professional growth and development
* Review charge capturing workflows to ensure efficiency and effectiveness. This includes:
* Improvement of department processes and procedures to assure timely and accurate capture of all chargeable activities;
* Development of action plan with responsible parties and due dates of issues identified;
* Development of policies and procedures, monitoring tools for late charges and establishment of procedures for timely and accurate charge capture mechanisms;
* Development and maintenance of collaborative working relationship with revenue producing departments, information systems personnel, technical and clinical personnel to identify chargeable activities, to establish charge capture mechanisms, and orderly and timely recording of revenue.
* Quarterly audit of the appropriateness of the accuracy of departmental charge capture modules/workflows. Prepares report of findings for management
* Actively participates in team development, contributes to dashboards, and in accomplishing team, departmental, and organizational goals and objectives.

Your qualifications should include:

* Bachelor's Degree (Experience may substitute for minimum education requirements).
* Minimum of three (3) years of experience working in Revenue Integrity/Charge Capture/Coding hospital and/or professional/ambulatory healthcare environment.
* At least three (3) years prior experience performing medical record /charge audit/claim audit reviews.
* Active certification as a Certified Coding Specialist (CCS) from the American Health Information Management Association (AHIMA); or Certified Professional Coders (CPC) from the (AAPC).
* Preferably: Minimum of five (5) years of experience working in Revenue Integrity/Charge Capture/Coding hospital and/or professional/ambulatory healthcare environment.

City of Hope is an equal opportunity employer. To learn more about our commitment to diversity, equity, and inclusion, please click here.