Revenue Integrity Specialist

This position is responsible for maintaining the integrity of the revenue capture system across the revenue generating departments of the hospital. Specifically, the focus of this position is to maximize collections through:

1. the accurate and complete capture of all charges;
   
2. the establishment of the appropriate charge structure and charge rates consistent with industry standards, local market conditions and contracts;
   
3. the maintenance of charge structure and charge master; 
   
4. the education of revenue-generating department leadership and directors as to their roles and responsibilities as they relate to revenue capture. 
   

Lastly, this position supports the corporate compliance program by verifying adherence to charge posting policies and procedures by ensuring that the charge master is in compliance with all applicable regulatory guidelines. This position oversees staff members as part of the revenue integrity team.

The primary responsibility of this position will be to:

1. Ensuring the accuracy and integrity of the revenue capture system across revenue generating departments. In this effort, coordinator will:
   1. Manage charge audit system to identify, resolve, and prevent missed charging opportunities
      
   2. Regularly reconcile charges with clinical documentation to ensure that documentation is complete and charges are capture appropriately
      
   3. Work with department leadership to develop and implement policies and procedures for purposes of reconciling charges posted in the billing system with other measures and sources of information; 
      
   4. Identify opportunities for charge capture improvement through the implementation routine and random audits; 
      
   5. Consults with department leaders to help develop and implement policies and procedures for the purposes of reconciling charges posted in the billing system with other source information
      
2. Developing, maintaining and enhancing charge master. Specifically, the Coordinator will:
   1. Review the charge structure of revenue generating departments to assure that charges accurately reflect services and supplies provided and are structured consistent with current industry accepted practices;
      
   2. Maximizes collections through recognition of terms and conditions of payor contracting
      
   3. Make recommendations to financial leadership regarding terms and conditions and charge increases with consideration of improving payments from third party payors.
      
3. Oversees maintenance and enhancement of charge master by: 
   1. Reviewing and approving changes in pricing, CPT codes, HCPCS codes and Revenue codes for accuracy and compliance to all applicable billing guidelines and optimization of reimbursement;
      
   2. Acting as a resource to revenue generating departments in establishing new charges using appropriate procedure codes;
      
   3. Determining the reimbursement impact of CPT revisions as well as charge additions and deletions. 
      
4. Maintains currency in regulatory issues that affect billing and compliance and educates directors and managers regarding potential changes in coding and billing regulations:
   1. Maintains currency with all regulatory issues affecting billing, reimbursement and compliance;
      
   2. Trains leadership of revenue generating departments in the management of their respective section of the charge master; 
      
   3. Ensure coordination between HIM and the charge master 
      

KNOWLEDGE/EXPERIENCE: 

• Three to five years’ experience in hospital charge capture review, medical record review, and claims auditing, and in working with regulatory and policy compliance issues related to federal and state programs
  
• Coding experience is a plus
  
• Clinical review experience is a plus
  
• Extensive knowledge of current healthcare trends, policies, and regulations
  
• Understanding of coding classification systems, such as ICD-10-CM, ICD-9-CM, MS-DRG, APR-DRG, and HCC strongly preferred
  
• Competency in developing efficient and effective solutions to complex business challenges
  
• Ability to influence key stakeholders at various organizational levels
  

EDUCATION: BS, BA, AA from an accredited school or equivalent work experience

LICENSE/CERTIFICATION/REGISTRY: N/A