Senior Revenue Integrity Specialist - Clinical Rev Integrity - Full Time 8 Hour Days (REMOTE) (Exempt) (Non-Union)

About this role

As the center of clinical charge capture, the Revenue Integrity (RI) Specialist provides leadership to the daily CDM maintenance workflow between the various entities of Keck Medical Center of USC and   monitors   the alignment of the various entities to the standard policy for   maintaining   the CDM. The RI Specialist   is responsible for   the   timely   and   accurate   synchronization of data between the CDM   residing   in the billing system and CDM management   tools .   The Senior RI Specialist shall ensure that the Chargemaster (CDM) is consistent with all coding and billing regulations and accurately   represents   services provided. This includes ensuring all annual updates required by Medicare and other third-party payers are up to date. The Senior RI Specialist delivers direction to the documentation of all policies and procedures regarding CDM Maintenance and charge   process;   and conducts meetings to evaluate department charge processes to improve charge capture and coding compliance. The Senior RI Specialist also coordinates with Keck Medical Center of USC Administration, IS, Compliance, Clinical Informatics and Integration personnel on technology projects impacting charge entry, charge dictionaries, and charge, and provides data derived from multiple entities of Keck Medical Center of USC for the management and support of critical decisions and functions related the Chargemaster, CDM Maintenance, and the improvement of charge capture. As a subject matter expert in the area of compliance and pricing of services, the Senior RI Specialist responds to inquiries regarding Chargemaster issues and is responsible for supervising 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. The Senior RI Specialist works closely with revenue auditors and provides leadership by providing direction to the revenue auditor team to all entities of Keck Medical Center of USC in the research and resolution of requests in a timely manner; and aid in the training and skill development of auditors to maximize available tools for Chargemaster and billing compliance.     Essential Duties:  

• Performs maintenance to the Keck Medical Center of USC Charge Description Master (Keck & Norris) ensuring all annual updates required by Medicare and other third-party payers are up to date. Assists the Revenue Cycle in annual coding review and processing of updates.  

• Reviews and process requests for new code additions, code set corrections, revenue code to CPT/HCPCS code mismatch corrections and on-going identified changes for current systems to   maintain   compliance with both state and federal regulatory agencies.  

• Leads and conducts meetings with Operations Leaders, Revenue Auditors, Clinical Department Staff, and Gatekeepers to address issues involving compliance with government regulations, third party payor needs and industry standards.  

• Acts a subject matter expert for projects that   impact   revenue integrity and CDM. Subject matter expert to meet and/or communicate with various stakeholders for projects that   impacts   revenue integrity and the CDM.  

• Takes the lead and exercises significant judgement and discretion on projects that have a broad, organizational impact.  

• Coordinates and provides leadership to   Revenue /Chart Audit team associated with research and resolution of account issues related to the CDM, charge capture, and other issues considered to be revenue integrity.  

• Synchronizes CDM data between CDM and CDM Workflow & Management Tool for Keck Medical Center of USC entities   on a monthly basis .  

• Imports/extracts data from various sources and in various formats as needed to review, monitor, track, and   maintain   the integrity of the CDM and associate charge flow process.  

• Provides CDM data as necessary based on   identified   issues in   form   of ad-hoc reports.  

• Provides guidance and education to ensure that CDM’s and Charge Capture as   needed of   exist and newly   acquired   entities ( i.e.   Verdugo Hills) follow the standards and policies of Keck Medical Center of USC.  

• Performs charge reconciliation activities, industry best practice research, and   identifies   and deploys charge capture improvement initiatives.  

• Interprets and   explains on   details of charge services provided as needed.  

• Participates collaboratively with Revenue Cycle and Ancillary team in the development, execution, and follow-up of education programs for USC Administration, Managers and Staff on all issues related to the charge master, charge capture, and new applications related processes.  

• Participates in the development of policies and procedures,   monitoring   tools for late   charges   and establishment of procedures for   timely   and   accurate   charge capture mechanisms.  

• Enhances professional growth and development  

• Actively   participates   in team development, contributes to dashboards, and in accomplishing team, departmental, and organizational goals and   objectives .  

• Performs other duties as assigned.  

Required   Qualifications:  

• Req   Associate’s Degree   Business Administration, Accounting, Finance, Healthcare Administration, Nursing, or similar/related   field .  

• Req Specialized/technical training Certification from an accredited program of Certified Coder (CPC/CCS/COC) or Certificate of Auditing (CPMA) within one year from date of hire.  

• Req 5   years Experience   in healthcare field   required . Related experience may include a combination of clinical service delivery (nursing or allied health), coding, provider billing, medical records, charge audit environment, CDM maintenance, Medicare/Medicaid reimbursement, managed care contractual arrangements, and patient accounting.  

• Req Experience with inpatient and outpatient billing re

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