Revenue Integrity Specialist

Job Summary:

Responsible for complete and accurate charge capture through review of medical record documentation of clinical services and procedures to ensure data integrity. Performs charge reconciliation activity to ensure optimal charge capture in accordance with Medicare, Medicaid or Third Party payor guidelines. Classification systems include ICD-9-CM, CPT, HCPCS as well as other specialty financial systems required for charging, billing and reimbursement analysis. The Revenue Integrity Specialist may be a resource to coding, reimbursement, and departmental areas for questions related to charges, auditing and the charge master.

Duties and Responsibilities:

Review medical records to identify clinical services and procedures eligible for revenue capture and charge scrubbing.

Ensures all documented, eligible clinical services and procedures are available for selection in the charge master and initiates and tracks charge intervention forms.

Interacts with physicians to clarify and accurately document patient diagnostic and procedural information as charged.

Enters charge information into the computerized databases.

Ensures timely record availability by meeting established bill hold standards.

Demonstrates a comprehensive knowledge of procedures outlined in ICD-9-CM, CPT, Medicare billing and compliance guidelines and other appropriate classification systems.

Maintains and complies with policies and procedures for confidentiality of all patient records.

Acts as an expert resource.

Performs other related duties as assigned.

Requirements:

High School Diploma Required; Associate’s Degree Preferred.

Must have at least 3 years of hospital or surgical center coding or billing experience which in the last 5 years, charge master experience preferred.

Certification in a focused area of the revenue cycle preferred.

Care New England Health System (CNE) and its member institutions, Butler Hospital, Women & Infants Hospital, Kent Hospital, VNA of Care New England, Integra, The Providence Center, and Care New England Medical Group, and our Wellness Center, are trusted organizations fueling the latest advances in medical research, attracting the nation’s top specialty-trained doctors, and honing renowned services and innovative programs to engage in the important discussions people need to have about their health.

Americans with Disability Act Statement: External and internal applicants, as well as position incumbents who become disabled must be able to perform the essential job-specific functions either unaided or with the assistance of a reasonable accommodation, to be determined by the organization on a case-by-case basis.

EEOC Statement: Care New England is an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status

Ethics Statement: Employee conducts himself/herself consistent with the ethical standards of the organization including, but not limited to hospital policy, mission, vision, and values.