revenue integrity specialist

Keck Medicine of USC

<div>As the center of clinical charge capture, the Revenue Integrity (RI) Specialist provides leadership to the daily CDM maintenance workflow between the various entities of Keck Medical Center of USC and monitors the alignment of the various entities to the standard policy for maintaining the CDM. The RI Specialist is responsible for the timely and accurate synchronization of data between the CDM residing in the billing system and CDM management tools . The Senior RI Specialist shall ensure that the Chargemaster (CDM) is consistent with all coding and billing regulations and accurately represents services provided. This includes ensuring all annual updates required by Medicare and other third-party payers are up to date. The Senior RI Specialist delivers direction to the documentation of all policies and procedures regarding CDM Maintenance and charge process; and conducts meetings to evaluate department charge processes to improve charge capture and coding compliance. The Senior RI Specialist also coordinates with Keck Medical Center of USC Administration, IS, Compliance, Clinical Informatics and Integration personnel on technology projects impacting charge entry, charge dictionaries, and charge, and provides data derived from multiple entities of Keck Medical Center of USC for the management and support of critical decisions and functions related the Chargemaster, CDM Maintenance, and the improvement of charge capture. As a subject matter expert in the area of compliance and pricing of services, the Senior RI Specialist responds to inquiries regarding Chargemaster issues and is responsible for supervising meetings for projects associated with educating and communicating to clinical revenue generating departmental staff regarding the CDM Maintenance process, coding updates, compliance issues, and charge capture improvement. The Senior RI Specialist works closely with revenue auditors and provides leadership by providing direction to the revenue auditor team to all entities of Keck Medical Center of USC in the research and resolution of requests in a timely manner; and aid in the training and skill development of auditors to maximize available tools for Chargemaster and billing compliance.
Essential Duties:
<ul><li>Performs maintenance to the Keck Medical Center of USC Charge Description Master (Keck &amp; Norris) ensuring all annual updates required by Medicare and other third-party payers are up to date. Assists the Revenue Cycle in annual coding review and processing of updates.
</li><li>Reviews and process requests for new code additions, code set corrections, revenue code to CPT/HCPCS code mismatch corrections and on-going identified changes for current systems to maintain compliance with both state and federal regulatory agencies.
</li><li>Leads and conducts meetings with Operations Leaders, Revenue Auditors, Clinical Department Staff, and Gatekeepers to address issues involving compliance with government regulations, third party payor needs and industry standards.
</li><li>Acts a subject matter expert for projects that impact revenue integrity and CDM. Subject matter expert to meet and/or communicate with various stakeholders for projects that impacts revenue integrity and the CDM.
</li><li>Takes the lead and exercises significant judgement and discretion on projects that have a broad, organizational impact.
</li><li>Coordinates and provides leadership to Revenue/Chart Audit team associated with research and resolution of account issues related to the CDM, charge capture, and other issues considered to be revenue integrity.
</li><li>Synchronizes CDM data between CDM and CDM Workflow &amp; Management Tool for Keck Medical Center of USC entities on a monthly basis.
</li><li>Imports/extracts data from various sources and in various formats as needed to review, monitor, track, and maintain the integrity of the CDM and associate charge flow process.
</li><li>Provides CDM data as necessary based on identified issues in form of ad-hoc reports.
</li><li>Provides guidance and education to ensure that CDM&rsquo;s and Charge Capture as needed of exist and newly acquired entities (i.e. Verdugo Hills) follow the standards and policies of Keck Medical Center of USC.
</li><li>Performs charge reconciliation activities, industry best practice research, and identifies and deploys charge capture improvement initiatives.
</li><li>Interprets and explains on details of charge services provided as needed.
</li><li>Participates collaboratively with Revenue Cycle and Ancillary team in the development, execution, and follow-up of education programs for USC Administration, Managers and Staff on all issues related to the charge master, charge capture, and new applications related processes.
</li><li>Participates in the development of policies and procedures, monitoring tools for late charges and establishment of procedures for timely and accurate charge capture mechanisms.
</li><li>Enhances professional growth and development
</li><li>Actively participates in team development, contributes to dashboards, and in accomplishing team, departmental, and organizational goals and objectives.
</li><li>Performs other duties as assigned.
</li></ul>Required Qualifications:
<ul><li>Req Associate&rsquo;s Degree Business Administration, Accounting, Finance, Healthcare Administration, Nursing, or similar/related field.
</li><li>Req Specialized/technical training Certification from an accredited program of Certified Coder (CPC/CCS/COC) or Certificate of Auditing (CPMA) within one year from date of hire.
</li></ul><ul><li>Req 5 years Experience in healthcare field required. Related experience may include a combination of clinical service delivery (nursing or allied health), coding, provider billing, medical records, charge audit environment, CDM maintenance, Medicare/Medicaid reimbursement, managed care contractual arrangements, and patient accounting.
</li><li>Req Experience with inpatient and outpatient billing requirements (UB-04) and CMS Medicare reimbursement methodology.
</li></ul><ul><li>Req Knowledge of other government and third-party payer reimbursement methodology required.
</li><li>Req Must be able to implement a systematic, self-motivated approach to problem solving and be able to identify, coordinate and optimize resources needed to execute plan
</li><li>Req Proficient skills and knowledge in MS Office/ Windows
</li></ul>Preferred Qualifications:
<ul><li>Pref Bachelor&rsquo;s Degree Business Administration, Accounting, Finance, Healthcare Administration, Nursing, or similar/related field.
</li><li>Pref Experience and knowledge of Hospital charging practices.
</li><li>Pref Healthcare operations experience, particularly in an acute care hospital setting.
</li><li>Pref Current knowledge of the Revenue cycle, specifically the flow of charges in and across hospital billing systems.
</li><li>Pref Previous hospital Chargemaster experience, including the use of CDM Maintenance software (Craneware or Med Assets).
</li><li>Pref Working knowledge of CPT, HCPCs and ICD9 coding principles.
</li><li>Pref Skills and knowledge on the following software: Cerner and Craneware
</li><li>Pref Registered Nurse - RN (CA Board of Registered Nursing)
</li><li>Pref Pharmacy Technician (CA DCA)
</li></ul>Required Licenses/Certifications:
<ul><li>Req Specialty Certification Certified Coder (CCS or CPC), Certified Outpatient Coder-COC (AAPC) or Certified Auditor (CPMA) obtained within one (1) year of date of hire.
</li><li>Req Fire Life Safety Training (LA City) If no card upon hire, one must be obtained within 30 days of hire and maintained by renewal before expiration date. (Required within LA City only)
</li></ul>The annual base salary range for this position is $95,680.00 - $158,230.00. When extending an offer of employment, the University of Southern California considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate&rsquo;s work experience, education/training, key skills, internal peer equity, federal, state, and local laws, contractual stipulations, grant funding, as well as external market and organizational considerations. 
USC is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status, disability, or any other characteristic protected by law or USC policy. USC observes affirmative action obligations consistent with state and federal law. USC will consider for employment all qualified applicants with criminal records in a manner consistent with applicable laws and regulations, including the Los Angeles County Fair Chance Ordinance for employers and the Fair Chance Initiative for Hiring Ordinance, and with due consideration for patient and student safety. Please refer to the Background Screening Policy Appendix D for specific employment screen implications for the position for which you are applying.
We provide reasonable accommodations to applicants and employees with disabilities. Applicants with questions about access or requiring a reasonable accommodation for any part of the application or hiring process should contact USC Human Resources by phone at (213) 821-8100, or by email at uschr@usc.edu . Inquiries will be treated as confidential to the extent permitted by law.
<ul><li>Notice of Non-discrimination
</li><li>Employment Equity
</li><li>Read USC&rsquo;s Clery Act Annual Security Report
</li><li>USC is a smoke-free environment
</li>Digital Accessibility 
<li>
</li></ul>If you are a current USC employee, please apply to this USC job posting in Workday by copying and pasting this link into your browser:
https://wd5.myworkday.com/usc/d/inst/1$9925/9925$144704.htmld</div>

Senior Revenue Integrity Specialist - Clinical Rev Integrity - Full Time 8 Hour Days (REMOTE) (Exempt) (Non-Union)

Providence

<div>Description
Senior Charge Description Master Specialist - Remote - Most States Eligible
As a member of the PSJH System Revenue Integrity Chargemaster (RICDM) Dept. team, the Senior CDM Specialist shall ensure that the Chargemaster (CDM) is consistent with all coding and billing regulations and accurately represents services provided. The Senior CDM Specialist acts as the liaison between the Hospital ministry and the PSJH System Revenue Integrity/Chargemaster (RI/CDM Department), and researches CDM maintenance requests for adherence to the PSJH System standard CDM in a timely manner. The Senior CDM Specialist responds to Hospital ministry inquiries regarding Chargemaster issues and is responsible for the training of Hospital ministry staff regarding the CDM Maintenance process, coding updates and charge capture improvement. The Senior CDM Specialist acts as a resource to other CDM Specialists in the research and resolution of requests in a timely manner; and is responsible for the training and skill development of the CDM Specialists to maximize available tools for chargemaster compliance. The Senior CDM Specialist coordinates the daily CDM maintenance workflow between the PSJH System and the Ministries and monitors the alignment of the individual ministries to the PSJH System's standard CDM. The Senior CDM Specialist is responsible for the documentation of all policies and procedures regarding CDM Maintenance and charge process; and is responsible for training Specialists to evaluate department charge processes to improve charge capture and coding compliance. The Senior CDM Specialist also coordinates with Hospital ministry, IS, Clinical Informatics and Integration personnel on technology projects impacting charge entry, charge dictionaries, and charge interfaces.
Providence caregivers are not simply valued &ndash; they&rsquo;re invaluable. Join our team at Revenue Cycle Business Services and thrive in our culture of patient-focused, whole-person care built on understanding, commitment, and mutual respect. Your voice matters here, because we know that to inspire and retain the best people, we must empower them.
Required Qualifications:
<ul><li>Bachelor's Degree in Healthcare, Nursing, Sciences, Finance, Accounting or other related field of study.
</li><li>Driving may be necessary as part of this role. Caregivers are required to comply with all state laws and requirements for driving. Caregivers will be expected to provide proof of driver license and auto insurance upon request.
</li><li>Minimum 5 years Hospital chargemaster experience, including the use of CDM Maintenance software and experience with inpatient and outpatient billing requirements (UB-04) and CMS Medicare reimbursement methodology. Knowledge of CPT, HCPCS and ICD10 coding principles.
</li><li>Three (3) years operational performance improvement and/or project management experience.
</li><li>Five (5) years experience working with Hospital EMR related to Chargemaster, preferably Epic EAP
</li><li>Three (3) years experience with CDM Maintenance tools/software such as Craneware, Vitalware, nThrive.
</li><li>Five (5) years experience with Hospital charging practices.
</li></ul>Preferred Qualification:
<ul><li>Coding experience.
</li></ul>Salary Range by Location:
AK: Anchorage: Min: $40.11, Max: $62.27
AK: Kodiak, Seward, Valdez: Min: $41.81, Max: $64.91
California: Humboldt: Min: $40.98, Max: $64.88
California: All Northern California - Except Humboldt: Min:$46.91, Max: $72.82
California: All Southern California - Except Bakersfield: Min: $41.81, Max: $64.91
California: Bakersfield: Min: $40.11, Max: $62.27
Idaho: Min: $35.69, Max: $55.41
Montana: Except Great Falls: Min: $32.29, Max: $50.13
Montana: Great Falls: Min: $30.59, Max: $47.49
New Mexico: Min: $32.29, Max: $50.13
Oregon: Non-Portland Service Area: Min: $37.39, Max: $58.05
Oregon: Portland Service Area: Min: $40.11, Max: $62.27
Texas: Min: $30.59, Max: $47.49
Washington: Western - Except Tukwila: Min: $41.81, Max: $64.91
Washington: Southwest - Olympia, Centralia &amp; Below: Min: $40.11, Max: $62.27
Washington: Tukwila: Min: $41.81, Max: $64.91
Washington: Eastern: Min: $35.69, Max: $55.41
Washington: South Eastern: Min: $37.39, Max: $58.05
Why Join Providence?
Our best-in-class benefits are uniquely designed to support you and your family in staying well, growing professionally, and achieving financial security. We take care of you, so you can focus on delivering our Mission of caring for everyone, especially the most vulnerable in our communities.
Accepting a new position at another facility that is part of the Providence family of organizations may change your current benefits. Changes in benefits, including paid time-off, happen for various reasons. These reasons can include changes of Legal Employer, FTE, Union, location, time-off plan policies, availability of health and welfare benefit plan offerings, and other various reasons.
About Providence
At Providence, our strength lies in Our Promise of &ldquo;Know me, care for me, ease my way.&rdquo; Working at our family of organizations means that regardless of your role, we&rsquo;ll walk alongside you in your career, supporting you so you can support others. We provide best-in-class benefits and we foster an inclusive workplace where diversity is valued, and everyone is essential, heard and respected. Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. As a comprehensive health care organization, we are serving more people, advancing best practices and continuing our more than 100-year tradition of serving the poor and vulnerable.
Posted are the minimum and the maximum wage rates on the wage range for this position. The successful candidate's placement on the wage range for this position will be determined based upon relevant job experience and other applicable factors. These amounts are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.
Providence offers a comprehensive benefits package including a retirement 401(k) Savings Plan with employer matching, health care benefits (medical, dental, vision), life insurance, disability insurance, time off benefits (paid parental leave, vacations, holidays, health issues), voluntary benefits, well-being resources and much more. Learn more at providence.jobs/benefits.
Applicants in the Unincorporated County of Los Angeles: Qualified applications with arrest or conviction records will be considered for employment in accordance with the Unincorporated Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act.
Requsition ID: 425736
 
Company: Providence Jobs
 
Job Category: Patient Financial Services
 
Job Function: Revenue Cycle
 
Job Schedule: Full time
 
Job Shift: Day
 
Career Track: Business Professional
 
Department: 4001 SS RC CHARGE DECR MSTR
 
Address: TX Lubbock 3615 19th St
 
Work Location: Covenant Medical Center
 
Workplace Type: Remote
 
Pay Range: $see posting - $see posting
 
The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.</div>

Senior Charge Description Master Specialist - Remote - Most States Eligible

St. Vincent's Hospital Westchester

<div><div>The Revenue Integrity Clinical Liaison serves as the critical link between clinical operations, finance, and coding/billing functions. They will ensure that every patient encounter is accurate; services charged and billed in accordance with clinical activity, compliance guidelines, and hospital policy.

This role focuses on bridging operational and financial workflows by validating and auditing OR supply utilization and charging practices confirming approved charge capture workflows are consistently followed across service lines.

The ideal candidate has a deep understanding of clinical documentation, charge capture processes, revenue integrity methodologies, and communication skills needed to drive collaboration between clinical and financial stakeholders.

Responsibilities
<ul>
<li>Conduct daily focused reconciliation audits on OR procedures, supply usage, and implant charges, validating against clinical documentation and charge master mappings.</li>
</ul><ul><li>Partner with finance, OR, billing and coding to analyze service charge capture trends, missed revenue, and denial patterns, to correct findings.</li>
<li>Participate in trouble shooting recurring charge errors or missing charges, escalating issues requiring system or process intervention.</li>
<li>Serve as liaison to supply chain and OR management to validate that approved charge workflows are being followed.</li>
</ul><ul><li>Support daily/weekly reconciliation processes, ensuring completeness and accuracy of OR/clinical revenue data.</li>
</ul>
Qualifications
<ul>
<li>Bachelor's degree in healthcare, finance, or related field.</li>
<li>Advanced Microsoft Excel a Must.</li>
<li>Experience in operating room or procedural area charge reconciliation.</li>
<li>Working knowledge of hospital charge master and revenue cycle operations.</li>
<li>Prior involvement in Oracle Health charge mapping or validation projects.</li>
<li>Minimum 2-3 years of experience in revenue integrity, charge audit, or coding operations.</li>
<li>Familiarity with charge reconciliation and supply chain charge workflows.</li>
<li>Proven ability to communicate effectively with both clinical and financial audiences.</li>
<li>Strong analytical, auditing, and problem-solving skills.</li>
<li>Ability to work independently, manage competing priorities, and meet deadlines in a complex healthcare environment.</li>
<li>Working knowledge of Oracle Health (Cerner Millennium+) or equivalent EHR systems.</li>
<li>Understanding of billing compliance regulations for ICD-10, CPT/HCPCS, preferred.</li>
</ul><div>Saint Joseph's Medical Center is an equal opportunity employer.</div>
</div>
 
Shift: Days
 
Compensation: $58,000-$65,000</div>

Revenue Integrity Clinical Liaison

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Senior Revenue Integrity Specialist - Clinical Rev Integrity - Full Time 8 Hour Days (REMOTE) (Exempt) (Non-Union)

Senior Charge Description Master Specialist - Remote - Most States Eligible

Senior Charge Description Master Specialist - Remote - Most States Eligible

Senior Charge Description Master Specialist - Remote - Most States Eligible

Senior Charge Description Master Specialist - Remote - Most States Eligible

Senior Charge Description Master Specialist - Remote - Most States Eligible

Revenue Integrity Clinical Liaison