Clinical Revenue Integrity Specialist
The Clinical Revenue Integrity Specialist will audit and examine charge capture data and revenue monitoring functions. The role has several components including reviewing charge capture monitoring and auditing revenue data. Also, review for accurate documentation and billing; based on government regulations, relying on clinical knowledge and experience.
- Regularly review charge capture including auditing patient billed charges and supporting documentation.
- Analyze billed charges, medical records and related medical documentation.
- Scrutinize processes and workflow to enhance maximum charge capture and reduce late fees.
- Perform daily analysis by identifying unusual items that are greater or lesser amounts than expected including and especially, high dollar charges.
- Follow up as appropriate when unusual items are noted and ensure problems are resolved and prevented in the future.
- Provide training related to revenue reports available and high-level items that leaders should be monitoring, including late charges.
Required Knowledge and Skills
- Knowledge of CPT-HCPCS, third party reimbursement methodologies, and revenue cycle process.
- Thorough understanding of the CDM relationship to general ledger, cost accounting, cost reporting, budget, coding, billing and compliance in a hospital setting.
- Expert knowledge of inpatient and outpatient billing requirements, coding guidelines and CMS Medicare reimbursement methodology.
- Must be flexible and be able to adjust in changing environments, including traveling to each Steward facility.
- Excellent communication and interpersonal skills with the ability to effectively interpret, communicate, and educate others.
- Experience in medical records review, claims processing or utilization/case management in a clinical practice or managed care organization.
- Experience with Meditech EHR and Patient Accounting.
- Other duties as assigned.
Education and Experience
- Education: Associate’s degree required. Bachelor’s degree preferred.
- Experience (Type & Length): 3 years’ related experience and/or training or equivalent combination of education and experience. Coding, compliance, and charge audit experience preferred.
- Certification/Licensure: RN/LPN/Case Management/Coding or clinical certification preferred.
- Software/Hardware: Proficient in using Microsoft Excel, PowerPoint and Word. Experience with Meditech EHR and Patient Accounting.
- Software/Hardware: Proficient in MS Office suite.
Job Status: Full Time
Job Reference #: 7474