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

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 requirements (UB-04) and CMS Medicare reimbursement methodology.

• Req Knowledge of other government and third-party payer reimbursement methodology required.

• Req Must be able to implement a systematic, self-motivated approach to problem solving and be able to identify, coordinate and optimize resources needed to execute plan

• Req Proficient skills and knowledge in MS Office/ Windows

Preferred Qualifications:

• Pref Bachelor's Degree Business Administration, Accounting, Finance, Healthcare Administration, Nursing, or similar/related field.

• Pref Previous hospital Chargemaster experience, including the use of CDM Maintenance software (Craneware or Med Assets).

• Pref Experience and knowledge of Hospital charging practices.

• Pref Healthcare operations experience, particularly in an acute care hospital setting.

• Pref Current knowledge of the Revenue cycle, specifically the flow of charges in and across hospital billing systems.

• Pref Working knowledge of CPT, HCPCs and ICD9 coding principles.

• Pref Skills and knowledge on the following software: Cerner and Craneware

Required Licenses/Certifications:

• Req Specialty Certification Certified Coder (CCS or CPC), Certified Outpatient Coder-COC (AAPC) or Certified Auditor (CPMA) obtained within one (1) year of date of hire.

• Pref Registered Nurse - RN (CA Board of Registered Nursing)

• Pref Pharmacy Technician (CA DCA)

• Req Fire Life Safety Training (LA City) If no card upon hire, one must be obtained within 30 days of hire and maintained by renewal before expiration date. (Required within LA City only)