Revenue Integrity Specialist - 40hrs

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.

Education and/or Experience

License and/or Certification Required

License and/or Certification Preferred

Knowledge

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