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Revenue Integrity Specialist
2 months ago
Job Summary:
The Revenue Integrity Specialist is a key member of the Prosum team, responsible for ensuring the accuracy and integrity of clinical charge capture and compliance with coding and billing regulations.
Key Responsibilities:
- Provide leadership and direction to the daily CDM maintenance workflow, ensuring timely and accurate synchronization of data between the CDM and billing system.
- Ensure the Chargemaster is consistent with all coding and billing regulations, and accurately represents services provided.
- Deliver direction to the documentation of all policies and procedures regarding CDM Maintenance and charge process.
- Conduct meetings to evaluate department charge processes and improve charge capture and coding compliance.
- Coordinate with Prosum Administration, IS, Compliance, Clinical Informatics, and Integration personnel on technology projects impacting charge entry, charge dictionaries, and charge.
- Provide data derived from multiple entities for the management and support of critical decisions and functions related to the Chargemaster, CDM Maintenance, and charge capture.
- Respond to inquiries regarding Chargemaster issues and supervise meetings for projects associated with educating and communicating to clinical revenue generating departmental staff regarding the CDM Maintenance process, coding updates, compliance issues, and charge capture improvement.
- Work closely with revenue auditors and provide leadership by providing direction to the revenue auditor team to all entities in the research and resolution of requests in a timely manner.
- Aid in the training and skill development of auditors to maximize available tools for Chargemaster and billing compliance.
Requirements:
- Associate's degree in Business Administration, Accounting, Finance, Healthcare Administration, or Nursing preferred.
- Credentialed Coder.
- Millennium Cerner Experience.
