Associate Revenue Integrity Specialist
About City of Hope
City of Hope, an innovative biomedical research, treatment and educational institution with over 5,000 employees, is dedicated to the prevention and cure of cancer and other life-threatening diseases and guided by a compassionate, patient-centered philosophy.
Founded in 1913 and headquartered in Duarte, California, City of Hope is a remarkable non-profit institution, where compassion and advanced care go hand-in-hand with excellence in clinical and scientific research. City of Hope is a National Cancer Institute designated Comprehensive Cancer Center and a founding member of the National Comprehensive Cancer Network, an alliance of the nation's 20 leading cancer centers that develops and institutes standards of care for cancer treatment.
The Revenue Integrity Associate is responsible for ensuring the City of Hope Charge Capture processes are in compliance with Federal/State guidelines, while ensuring that the CDM is accurately reflecting all line items correctly for billing to payors, patients, and Research sponsors.
Revenue Integrity Associate is a certified coder who possesses clinical knowledge and professional/technical skills and is responsible for the audit functions of the City of Hope Medical Center charge capture and Research Billing charge correction functions. The Revenue Integrity Associate utilizes coding knowledge to properly identify documentation that reflects and supports the transactions of services rendered to the patients.
The Revenue Integrity Associate also serves as a patient advocate and promotes customer satisfaction by appropriately explaining and resolving charge discrepancies. The Revenue Integrity Associate participates in departmental and organizational performance improvement activities and appropriately communicates audit findings.
- Analyzes charge transactions along with Research documentation to properly bill Research sponsors for protocol related services provided to the patient
- Verifies medical procedure documentation and completeness of the Medical Record.Requests documentation as needed to support charges.
- Coordinates/conducts entrance and exit audit interviews with third party payers in relation to patient bills. Recommends to management the appropriate actions and strategies to be taken.
- Reviews medical records for appropriate documentation to appeal proposed clinical and technical denials
- Conducts special patient charge studies for various departments.Develops data and provides interpretation of intangible or unusual factors and summarizes findings appropriately.
- Maintains a record of audit account activity and takes appropriate follow-up actions.
- Interprets and explains to patients or family members the details of medical services provided, if requested.
- Conducts department in-service training on an as needed basis.
- Review charge capturing workflows to ensure efficiency and effectiveness. This includes:
- Improvement of department processes and procedures to assure timely and accurate capture of all chargeable activities;
- Development of action plan with responsible parties and due dates of issues identified;
- Monitoring WQs, revenue and tools for late charges and establishment of procedures for timely and accurate charge capture mechanisms;
- Development and maintenance of collaborative working relationship with revenue producing departments, information systems personnel, technical and clinical personnel to identify chargeable activities, to establish charge capture mechanisms, and orderly and timely recording of revenue.
- Works with PFS (Denials, Billing and 3rd Party) to identify issues related to NCCI edits, modifier issues, denied charges for hospital services, and updates charges in accounts accordingly.
- Serves as a regulatory resource of Medicare, Medicaid, Medicaid OPPS reimbursement and other 3rd party billing rules and coverage through self-directed education and communication to departments.
- Actively participates in team development, contributes to dashboards, and in accomplishing team, departmental, and organizational goals and objectives.
- Report weekly productivity to Manager
- Maintains personal professional growth and development through seminars, workshops and professional affiliations
- Service quality and work quality to meet required COH, state and federal rules and regulations.
- Utilizes work quality monitoring to insure that policies and procedures, objectives, performance improvement, attendance, safety and environment, and infection control guidelines are followed.
- Adhere to current organizational Performance Improvement priorities.
- Participate in quality studies through data collection.
- Make recommendations and take actions to improve structure, system or outcomes.
- Ensures that compliance to rules, regulations, operations, contracts, internal and external rules, state and federal requirements are met.
- Associate's Degree.Experience may substitute for minimum education requirements.
- One (1) or more years relevant experience in a hospital setting, healthcare system, working with a hospital and professional Charge Capture or Charge Description Master.
- Active certification as a Certified Coding Specialist (CCS) from the American Health Information Management Association (AHIMA); or Certified Professional Coders (CPC) from the (AAPC).
- At least two (2) years relevant experience in a hospital setting, healthcare system, working with a hospital and professional Charge Description Master preferred.
- Research billing
- Significant clinical and/or clinical coding knowledge; background in billing compliance desired
- Must have technical knowledge of correct coding principles of CPT/HCPCS and modifier selection as well as UB-04 revenue codes.
- Must have technical knowledge of correct coding principles of CPT/HCPCS and modifier selection, as well as, UB-04 revenue codes.
- Experience with medical record to bill reviews for charge capturing accuracy.
- MS Office, required
- MS Windows, required
- Epic and Craneware preferred
Working / Environmental Conditions
- Occasionally subjected to irregular hours Occasional pressure due to multiple calls and inquiries Occasionally covers varied shifts, weekends and holidays Occasional travel required
- Atmosphere and environment associated with an office setting
City of Hope is committed to creating a diverse environment and is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sex, sexual orientation, gender identity, age, status as a protected veteran, or status as a qualified individual with disability.
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