Revenue Integrity Specialist

1 month ago

Chicago, United States Thorek Memorial Hospital Full time

Thorek Memorial Hospital is a stable community hospital with its roots in Chicago for over 100 years. We are dedicated to excellence in patient care, serving our community, and committed to the continued learning of our employees.

We are currently seeking for a full-time Revenue Integrity Specialist to join our accounting department.

**GENERAL SUMMARY**: Reports to the Revenue Cycle Director. Responsible for the overall management of the Hospital’s revenue cycle and charge integrity structure. Responsible for charge capture initiatives, develops processes and procedures to ensure accurate and timely capture of all chargeable procedures. This position works closely with all members of the clinical team and department leadership to develop systems, processes and plans to improve charge capture. Works closely with billing team and coders to identify potential charge and coding gaps to address any billing discrepancies.

**ESSENTIAL FUNCTIONS**:
1. Daily review of charge items & Revenue Integrity work queues to ensure they are resolved accurately and in a timely manner to meet the deadlines.

2. Analyze billed charges, medical records and related medical documentation to look for missing, incorrect or late charges.

3. Evaluate charge capture practices for their assigned facilities to ensure accuracy & completeness of charge capture and compliance with government and non-government payer’s rules and regulations.

4. Follow up as appropriate when unusual items are noted and ensure problems are resolved and prevented in the future.

5. Maintain working knowledge of CPT and HCPCs coding as well all billing, CCI, MUEs, and other relevant coding/ billing guidelines.

6. Provide recommendation based on finding to improve charge capture workflows and to standardize charge capture practices.

7. Reports on trends, findings, and opportunities for improvement to managements detailing findings and high-risk items that leaders should be monitoring, including missing, incorrect, and late charges.

8. Work closely with individual facilities representatives/clinical staff to establish and maintain positive relations to ensure revenue integrity goals are achieved. Participate in onsite meetings and interact on regular basis with site-based department leaders regarding changes in charge capture practice.

9. Performs database editing/auditing functions to maintain and/or improve data quality.

10. Completes analytical assessment of reporting to identify missed revenue opportunities and areas for potential revenue enhancement.

11. Applies analytical skills to daily work to identify trends or root causes and provides recommendations to improve processes across the revenue cycle (missing or delayed charges, lag time, claim denials, etc.)

12. Able to communicate clearly to provide education to administrative staff. Keeps abreast of government and commercial payor updates and changes to billing requirements. Monitors denials to identify trends and recommend solutions. Ability to work independently, analyze data and use judgement to make independent decisions is critical to this position.

13. Other duties as assigned.

**Educations**: Coding certification is required such as RCC, RCCIR, CPC, COC, CIRCC, CCS, CCS-P, Knowledge and understanding of hospital revenue cycle operations, 3-5 years’ experience in revenue cycle operations and/or clinical operations. Meditech experience is preferred.

**Skills**: Word processing, in-depth knowledge of hospital and physician billing and reimbursement, leadership in the core values of organization, clear and effective communication skills, a mature approach to problem-solving for all types of issues, negotiating skills, detail orientation and experience with total quality management concepts and tools; knowledge of healthcare industry financial statistical indicators.

**Benefits**:

- 401(k)
- Dental insurance
- Health insurance
- Life insurance
- Paid time off
- Vision insurance

**Schedule**:

- 8 hour shift
- Day shift
- Monday to Friday

**Thorek is an Equal Opportunity Employer**

Ability to Relocate:

- Chicago, IL 60613: Relocate before starting work (required)

Work Location: In person

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