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City of Hope

Revenue Integrity Specialist

Duarte, CA

About City of Hope

City of Hope, an innovative biomedical research, treatment and educational institution with over 6000 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 leading cancer centers that develops and institutes standards of care for cancer treatment.

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Position Summary:

This role serves as a charge capture/charge description master expert to clinical service line leaders and processes are in compliance with Federal/State guidelines. This position identifies revenue opportunities and works collaboratively with Revenue Cycle staff to develop a work plan to ensure process improvement is understood by departmental managers and staff and is documented throughout the revenue cycle with the expected outcome being increased revenue capture and decreased denials.

Another objective of the Revenue Integrity Specialist is to analyze charge transactions along with Research documentation to properly bill Research sponsors for protocol related services provided to the patient. 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.

Key Responsibilities include:
  • 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.
  • Serves as charge capture/charge description master expert to clinical service line leaders for all areas.
  • Monitoring on specific clinical service lines to ensure best practices. Champions standardization of charge capture process, and ensures appropriate discipline-specific charge capture as it relates to government and commercial payer requirements.
  • Performs charge reconciliation activities, industry best practice research, and identifies and deploys charge capture improvement initiatives.
  • Ensures charge capture revenue management opportunities are identified and service line specific reimbursement and revenue management is reviewed and monitored.
  • Coordinates with CDM Analyst, Billers, and Auditors to identify revenue management opportunities, conducts charge reconciliation to ensure optimal charge capture, and reviews and monitors service line specific information regarding hospital services, reimbursement, and revenue management
  • Conducts routine on-site meetings with clinical staff and all hospital departments to ensure all charges are being captured and reported accurately using the correct charging methodology
  • Identifies system-wide best practices by specialty and works with all affiliates to establish best practices in that specialty throughout City of Hope
  • Collaborates with the Denial Management team, Auditors and Billing ream in order to contribute to resolving claims issues
  • Stays current with government and commercial payer billing and charging regulations/requirements and industry charge capture best practices
  • Participates in charging and billing decisions/interpretations at the department and system-wide level and ensures proper documentation for all services rendered by the department
  • Assist with review and perform manual charge entry/correction as needed.
  • Participates collaboratively with Revenue Cycle team in the development, execution and follow-up of education programs for City of Hope Administration, Managers and Staff on all issues related to the charge master and charge capture related processes.
  • Collaborates with Denial Management team, Compliance, and other departments to prepare and deliver educational materials regarding accurate charging, billing and documentation for customers
  • Participates in special projects as assigned
  • Enhances professional growth and development
  • 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;
  • Development of policies and procedures, monitoring 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.
  • Quarterly audit of the appropriateness of the accuracy of departmental charge capture modules/workflows. Prepares report of findings for management
  • Actively participates in team development, contributes to dashboards, and in accomplishing team, departmental, and organizational goals and objectives.
Basic education, experience and skills required for consideration:
  • Bachelor's Degree.
  • Experience may substitute for minimum education requirements.
  • Minimum of three (3) years of experience working in Revenue Integrity/Charge Capture/Coding hospital and/or professional/ambulatory healthcare environment.
  • At least three (3) years prior experience performing medical record /charge audit/claim audit reviews.

Required Courses/Training:
  • Active certification as a Certified Coding Specialist (CCS) from the American Health Information Management Association (AHIMA); or Certified Professional Coders (CPC) from the (AAPC).

Additional Information:
  • To protect the health of patients and staff and to comply with new State of California mandates, City of Hope staff are required to show proof of full vaccination by September 30, 2021. Compliance is a condition of employment.

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.

  • Posting Date: Dec 6, 2021
  • Job Field: Business Services
  • Employee Status: Regular
  • Shift: Day Job

Job ID: CityOfHope-10014474
Employment Type: Other