Revenue Integrity Specialist
Job DescriptionReporting to the Charge Capture Manager, the Revenue Integrity Specialist is responsible for working with revenue producing clinical departments/service lines across the Inova enterprise to ensure efficient, accurate, and compliant charge capture and charge reconciliation processes. They will align with department/service line leadership and serve as the subject matter expert regarding accuracy of charge capture processes including education, audit activities, changes or risk to revenue (regulatory or coding changes), and monitoring of charge capture related metrics to minimize revenue leakage. Duties include but are not limited to working with service line leaders to ensure regulatory compliance for new and existing services, implementing charge capture process improvements and annual updates to CPT/HCPCS code selections. Collaborates with service lines, HIM, and other key stakeholders to improve charge capture, compliant documentation to substantiate charges, charge reconciliation, and compliant billing of all charges.
- Meet with department liaisons to review and interpret revenue cycle reports to drive accountability and transparency in performance;
- Work closely with Health Information Management (HIM), Clinical Documentation Improvement (CDI), Clinical Informatics, and Patient Financial Services (PFS) departments to resolve charge capture related issues;
- Identify service line revenue trends and compile information to determine quarterly focused reviews of specific departments;
- Develop an analytics structure that validates the accurate capture and reporting of charges, as well as identifies any issues present;
- Coordinate and manage Revenue Integrity and charge capture service line projects;
- Identify and implement solutions that support more efficient and effective charge capture and reconciliation;
- Maintain knowledge of any CDM requests for the assigned department(s)/service lines(s) and support effective implementation and education;
- Assess and validate revenue and usage and denials data and root cause any variances;
- Maintain knowledge of Electronic Health Record (EHR) reports and resources available to RI team by working collaboratively with EHR IT;
- Participate actively in team development, achieving KPIs, and accomplishing department goals;
- Monitors charge review WQs and assists service line staff, as needed, to resolve and proactively prevent charging edits;
- Provides ongoing education support to department/service line staff on charge capture and charge reconciliation workflows.
Bachelor’s Degree or 5 years of relevant experience in lieu of degree.
General knowledge of healthcare revenue cycle including familiarity with reimbursement methodologies, coding, CDM, charge capture, and billing processes
- Demonstrated leadership ability including ability to work in a team, build consensus, problem-solve, influence others outside a direct reporting relationship, and handle conflict professionally.
- Intermediate computer skills including use of email, spreadsheets, word processing, and reports.
@@Previous Revenue Integrity, clinical, or coding experience preferred.