Revenue Integrity Specialist - 40hrs

Reporting to the Director Health Information Management and Revenue Integrity, the Revenue Integrity Specialist (RIS) plays an important role in Connecticut Children’s Medical Center and Connecticut Children’s Specialty Group, by improving revenue results through a global view of clinical and financial processes, functions and interdependencies from the time the patient is scheduled to final bill generation.  This position is responsible for providing support to hospital and professional departments in training and maintaining charge capture processes to ensure revenue integrity is being maintained. The RIS will play a major role in optimizing reimbursement for services rendered and ensuring compliance with applicable laws and regulations.  Responsible for working with hospital and professional clinical departments and practices, which requires strong interpersonal and communication skills, well-developed analytic and organizational skills, and the ability to influence others to meet deadlines.

• 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.
   

Education and/or Experience:

• Education Required: High School Diploma, GED or equivalent.
• Education Preferred: Bachelor’s Degree, or AS degree. 
• Experience Required: Minimum 3 years professional and/or facility billing experience. 3+ years’ experience preferred.

License and/or Certification Required:

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

License and/or Certification Preferred:

• Dual CPC and CCS Certifications.

Knowledge, Skills and Abilities Required:

Knowledge:

• 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.

Skills:

• 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.
• Working knowledge of multiple healthcare applications; Epic experience highly desired.
• 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.

Ability to:

• Prioritize multiple tasks to ensure all responsibilities of position are addressed in a timely manner.
• Ability to interpret and implement regulatory standards.