Revenue Integrity Specialist

FLSA STATUS

Non-exempt

• Associate’s degree or higher in billing, coding, accounting, or related field; or high school diploma with additional two years of related experience (in addition to the minimum experience requirements listed below) in lieu of college degree

• Three years of experience in patient accounting, revenue cycle, coding, or other related area

• Demonstrates the skills and competencies necessary to safely perform the assigned job, determined through on-going skills, competency assessments, and performance evaluations
• Sufficient proficiency in speaking, reading, and writing the English language necessary to perform the essential functions of this job, especially with regard to activities impacting patient or employee safety or security
• Ability to effectively communicate with patients, physicians, family members and co-workers in a manner consistent with a customer service focus and application of positive language principles
• Familiarity with general International Classification of Disease (ICD) and Current Procedural Terminology (CPT) coding
• Knowledge of medical terminology
• Understanding of accreditation and government regulations (e.g., CMS) as applicable to scope of department
• Ability to be self-motivated and work independently with minimal supervision
• Proficient computer skills in Microsoft Office components, including Excel, and ability to learn and navigate multiple software programs
• Ability to think critically, analyze and solve problems
• Strong organizational skills
• Ability to handle detail work accurately and rapidly
• Ability to follow-through and handle multiple tasks simultaneously

• Promotes a positive work environment and contributes to a dynamic team focused work unit that actively helps one another to achieve optimal departmental and organizational results.
• Develops, fosters and maintains a network of all organizational stakeholders involved in charge entry and processing to assist in the efficient resolution of charge reconciliation issues. Responds to questions regarding charge capture, serves as a subject matter expert in the area of charge capture, and trains/mentors others in related charge capture roles.

• Performs data entry of clinical and/or operational information from worksheets and other data collection and reporting tools. Accurately enters all data into applicable databases ensuring timeliness and prevention of backlog. Identifies errors, performs problem solving, makes edits and updates records accordingly.
• Handles work queues daily, organizes workflow, problem-solves, and manages multiple ongoing priorities with minimal supervision. Generates, copies, and distributes reports as directed by management.
• Independently utilizes available resources to include electronic tools (e.g., electronic health records, spreadsheets, etc.) to gain understanding of process and edits in order to identify and resolve charge correction and/or registration issues.
• Works daily with external and/or internal areas such as payors (where appropriate), information technology, registration, health information management, and/or billing to address edit issues that require specialized analysis; triages issues to appropriate department(s) to promote resolution identified.

• Evaluates charges and validates accuracy. When inaccurate, makes revisions by adding, editing, and/or deleting inappropriate charges.
• Identifies and corrects charging errors involving transfer of charges to correct accounts as appropriate.
• Maintains current and accurate Charge Description Master (CDM) in accordance with coding regulations and guidelines and updates procedure codes as required.
• Maintains strict confidentiality of patients, employees and hospital information at all times. Ensures protection of private health and personal information. Adheres to all Health Insurance Portability and Accountability Act (HIPAA) and Payment Card Industry (PCI) compliance regulations.

• Ensures charges are audited, entered, and confirmed within timeframe set forth by…