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Connecticut Children's · 1 week ago

Revenue Integrity Specialist - 40hrs

Hartford, CT

Full-time

Onsite

Mid Level

3+ years exp

Connecticut Children's is a dedicated health system focused exclusively on children, offering personalized medical care across various pediatric specialties. The Revenue Integrity Specialist plays a crucial role in improving revenue results by ensuring compliance with billing processes and optimizing reimbursement for services rendered.

Health CareHospitalMedical

Responsibilities

Participates in team huddles with the professional coders and HIM. Provides support and serves as a resource for professional coding staff. Escalates staffing concerns to the appropriate designee(s) to ensure adequate coverage for services provided

Assists with monitoring overall processes to help ensure accurate coding, billing and reimbursement for assigned hospital and professional clinical departments

Responsible for evaluating and managing the workflows for related coding software systems. Assist implementation, education and training of same

Assists with implementing/maintaining Revenue Integrity strategic goals

Helps to implement/monitor new or current workflows to identify revenue leakage or waste. Coordinates and facilitates problem resolution sessions where multiple departments and/or service areas are involved

Sets up and provides oversight for internal monitoring with in the departments for new and existing processes

Provides new and ongoing provider/clinical department guidance, communication and education on correct documentation and/or charge capture to assigned hospital and professional clinical departments to ensure understanding and compliance

May initiate and assist training to assigned hospital and professional departments on identified revenue integrity issues and/or process improvement to clinical providers, staff, and management

Assists in executing Revenue Integrity work plans to adapt systems and processes to effectively accommodate change in assigned hospital and professional clinical departments

Responsible for collaboratively assisting department leadership in initiating and maintaining internal ongoing monitoring processes that would ensure accurate and timely documentation and/or charge capture process for all rendered services

Identifies charge compliance issues and root causes of noncompliance and immediately brings any identified non-compliance to the appropriate designee(s)

Reviews, researches, and documents trends with a focus on identifying charging and documentation opportunities for assigned hospital and professional departments

Initiates/maintains monitoring process to identify potential discrepancies between codes, regulations, contracts, and documentation

Assists with annual CPT updates, government billing and coding guidelines review, and coordinates updates with IT and other key stakeholders for assigned hospital and/or professional departments

Participates in the development and implementation of Revenue Integrity policies/procedures in coordination with the Revenue Integrity and Revenue Cycle teams

Partners with Revenue Cycle and/or Finance departments and key organizational stakeholders with changes for implementation or expansion of services in assigned hospital and/or professional departments. Collaborates with providing department education as needed

Demonstrates support for the mission, values and goals of the organization through behaviors that are consistent with Connecticut Children’s standards, policies, and procedures

Participates in continuing education to enhance knowledge and skills and to maintain current credentials

Qualification

CPC CertificationCCS CertificationRevenue Code KnowledgeCPT KnowledgeICD-10 KnowledgeEpic ExperienceMicrosoft ExcelInterpersonal SkillsCommunication SkillsOrganizational SkillsTime Management Skills

Required

Education Required: Bachelor's Degree, or AS degree with experience

Experience Required: Minimum 3 years professional and/or facility billing experience. 3+ years' experience preferred

CPC or CCS Certification obtained within 1 year of hire into role

Significant revenue code, Medical Terminology, CPT, ICD-10, NCCI Edits and HCPCS coding knowledge

Solid understanding of multiple reimbursement systems including IPPS, OPPS, and Fee Schedule

Working knowledge of payer policies and claim billing

Working knowledge of multiple healthcare applications; Epic experience highly desired

Basic knowledge of Microsoft Word, Excel

Excellent interpersonal and communication skills to positively interact with a variety of hospital personnel, including administrative and management staff

Well-developed research, organizational and project management skills

Must have excellent customer service skills

Possess effective oral and written skills, including presentation skills

Possess effective time management skills to permit handling of large workload

Prioritize multiple tasks to ensure all responsibilities of position are addressed in a timely manner

Ability to interpret and implement regulatory standards

Preferred

Dual CPC and CCS Certifications

3+ years' experience preferred

Epic experience highly desired

Company

Connecticut Children's

Connecticut Children’s is a leading pediatric academic medical center consistently ranked by our peers as among the best children’s hospitals in the nation.

Founded in 1996

Hartford, Connecticut, USA

1001-5000 employees