Revenue Integrity Clinical Systems Specialist

Silver Cross Hospital•New Lenox, IL

About The Position

The Revenue Integrity Clinical Systems Specialist monitors and analyzes charging policies and practices across hospital departments, then applies and communicates that information to clinical and non-clinical management to support accurate, compliant charging and optimized reimbursement. The role conducts and completes insurance audits through site visits by insurance auditors and acts as a liaison and interpreter of clinical information related to billing for patients and hospital departments. The specialist identifies process breakdowns with financial impacts and coordinates work groups to resolve them. The role educates staff on billing policies, monitors reimbursement and denial trends, and works with clinical leaders to improve charge capture and documentation. It also maintains the Charge master in collaboration with clinical departments, Patient Accounts Management, Revenue Cycle Leadership, and Accounting; manages MCO-authorized inpatient and outpatient services; provides coding feedback to billing and collection staff; appeals clinical denials verbally and in writing; and assists with obtaining authorizations for current in-house patients.

Requirements

Associate of Science degree in a medically related field.
At least two years of previous experience in a Patient Accounting environment.
Intermediate-level Microsoft Excel skills.
If an RN, current State of Illinois licensure.
If a coder, Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA), or Certified Coding Specialist (CCS) credential.

Nice To Haves

Bachelor’s degree in Accounting or Bachelor of Science in Nursing.

Responsibilities

Monitor and analyze charging policies and practices across hospital departments to facilitate correct and compliant charging and optimize reimbursement.
Conduct and complete insurance audits through site visits by insurance auditors.
Act as a liaison and interpreter of clinical information related to billing for patients and hospital departments.
Identify process breakdowns with financial impacts and coordinate appropriate work groups to resolve them.
Educate clinical and non-clinical staff on billing policies.
Keep up to date on reimbursement and denial trends.
Work with clinical leaders to develop and improve charge capture and documentation.
Update and maintain the Charge master in collaboration with clinical departments, Patient Accounts Management, Revenue Cycle Leadership, and Accounting.
Manage Managed Care Organization (MCO) authorized services for inpatient and outpatient populations.
Ensure correct coding and provide feedback to billing and collection staff when questions arise.
Appeal clinical denials, verbally and in writing, regardless of the denial source.
Assist in obtaining authorizations for current in-house patients.