Revenue Integrity Specialist

Revenue Integrity Specialist

Summary:
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 our client 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 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 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 RI Specialist also coordinates with the company's 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 the company 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 compliance and pricing of services, the 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 RI Specialist works closely with revenue auditors and provides leadership by providing direction to the revenue auditor team to all entities of the company 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/Experience:

• Associate's degree in Business Administration, Accounting, Finance, Healthcare Administration or Nursing preferred
• Must be Credentialed Coder
• Must have Millennium Cerner Experience

Primary Accountabilities:

• Correction of charge errors/missing charges and infusion charge capture
• Other duties as assigned

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