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.

Minimum Education:
Required:
• Associates degree in Business Administration, Accounting, Finance, Healthcare Administration or Nursing.
• Certified Coder (CPC/CCS).
Preferred:
• Bachelor’s Degree
• RN, BSN

Minimum Experience/Knowledge:
Required Position Qualifications:
• Minimum Five (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.
• Experience with inpatient and outpatient billing requirements (UB-04) and CMS Medicare reimbursement methodology.
• Knowledge of other government and third-party payer reimbursement methodology required.
• 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
• Proficient skills and knowledge in MS Office/ Windows

Preferred Position Qualifications:
• Previous hospital Chargemaster experience, including the use of CDM Maintenance software (Craneware or Med Assets).
• Experience and knowledge of Hospital charging practices.
• Current knowledge of the Revenue cycle, specifically the flow of charges in and across hospital billing systems.
• Working knowledge of CPT, HCPCs and ICD9 coding principles.
• Healthcare operations experience, particularly in an acute care hospital setting.
• Skills and knowledge on the following software: Cerner and Craneware

Required/Preferred License/Certification:
Required:
• Certified Coder (CCS or CPC)
• Fire and Safety Certification. If no card upon hire, one must be obtained within 30 days of hire, and maintained by renewal before expiration date (applicable to employees working within City of LA).
Preferred:
• RN licensed
• Pharmacy Tech