Revenue Integrity Specialist

Position Summary The Revenue Integrity Specialist will perform concurrent, pre-bill and retrospective audits of billed charges against medical records to identify missing revenue. S/he will identify departments that are not charging properly and work with them to develop appropriate and standard charging practices. S/he will work along with the pre-bill edit team to take appropriate action to resolve the issues and communicate to the revenue cycle departments when changes need to be made. S/he will work closely with all areas of the Revenue Cycle to ensure that proper charge activity occurs allowing the Medical Center to obtain full and compliant reimbursement for services provided.

• Serves as revenue liaison between Revenue Cycle Management division, billing and collections department, ancillary/clinical areas, and any provider areas that generate patient revenue.
• In particular, responsible for collaborating with department revenue leads, front-line staff, and current revenue integrity team in order to ensure accurate, sustainable and regulatory compliant charge capture operations are in place, including daily charge entry, revenue reconciliation and error correction processes.
• Responsible for evaluating current charge capture systems and processes in place against regulatory guidelines, billing documentation requirements, and leading hospital practices, and making recommendations for enhancement to Revenue Cycle Administration.
• For those system enhancement or implementation projects approved and related to charge capture, serves as project coordinator, consistently communicating regulatory protocols, and ensuring sufficient data guides all major implementation decisions.
• Throughout specified revenue cycle optimization tasks, being responsible for creation of implementation strategies and data production, working with vendors and SMC representatives, in order to ensure objectives are achieved, communicating progress and issues to management, and each project achieves improvements for which it was acquired.
• Following change or new process, implementation provides ongoing data support, communicating feedback to appropriate departments, and ensures all systems are in place and functioning correctly.
• Responsible for compiling and monitoring revenue cycle performance indicators against budgeted targets and SMC or industry benchmarks available.
• Will provide as needed billing and collection education to appropriate Patient Financial Services staff.
• Serves as resource for revenue cycle managers, by assisting them with analysis of current performance through data support, and helping them interpret data, when possible, in order to identify process improvements that support provision of consistent, compliant, customer driven, and results-oriented revenue cycle services within SMC.
• Perform retrospective bill audits to identify inappropriate and/or missing charges
• Review UB-04 claims identified by an automated charge capture review tool to have missing charges or overcharges addressed. Research to determine if system findings are valid and charges can be added to the patient's account
• Post charge in patient account or coordinate with a business office to post charges
• Identity departments that have chronic charging issues and establish appropriate and standard charging practices
• Identify billing or charging issues related to Chargemaster and make appropriate CDM changes when appropriate.
• Serve as a resource for clinical and support departments for correct charging practices.
• Support the charge master functions, make necessary recommendations based on the knowledge of laws, regulations and rules applicable to billing governmental payers
• Perform DDE history check, verification of Inpatient Outlier DRG and Outpatient Outlier report
• Review at month end accounts that are in preadmit status and have charges posted to them
• Support the charge master functions, make necessary recommendations based on the knowledge of laws, regulations and rules applicable to billing governmental payers
• Patient combine accounts, combining medical record numbers in AX when patients are registered incorrectly
• Bankruptcy & Legal cases follow up on the outstanding payments Qualifications
• High School Graduate/GED / Equivalent Work
• 2-4 years Patient Billing Experience
• Ability to communicate both verbally and in writing
• Demonstrated knowledge of office technology in a Windows-based environment
• Detail oriented; strong written and communication skills
• Knowledge of federal and state laws, and regulatory requirements regarding HIPAA
• Ability to organize, prioritize, and manage multiple projects and ensure completion
• Demonstrated knowledge of Word Processing and Spreadsheets
• Knowledge of federal and state laws, and regulatory requirements relative to the Revenue Cycle
• Knowledge of Medical Terminology
• Ability to keep job acquired information confidential Additional information
• To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed above are representative of the knowledge, skill, and/or ability required.
• This job description should not be construed as an exhaustive statement of duties, responsibilities or requirements, but a general description of the job. Nothing contained herein restricts the company's rights to assign or reassign duties and responsibilities to this job at any time.
• Shore Medical Center is an Equal Opportunity Employer.

All applicants will receive consideration for employment without regard to sex, affectional or sexual orientation, gender, gender identity, orientation or expression; marital status, domestic partnership status, civil union status, pregnancy, race, creed, ancestry, color, ethnicity, national origin, age, disability, religion, genetic information, or veteran status or any other basis prohibited by law.