Revenue Integrity Specialist, Full Time - Days

University of Chicago • Chicago, IL

70d • Remote

About The Position

Be a part of a world-class academic healthcare system, Uchicago Medicine, as a Revenue Integrity Specialist in the Lab Administration department. This position will be primarily a work from home opportunity with the requirement to come onsite as needed. You may be based outside of the greater Chicagoland area. This role supports timely processing of all (~4.9M billables) Clinical Labs Part A claims submission and resolves problems with denied claims. The Lab Administrative department is crucial for maintaining all key billing and auditing needs of the reference laboratories. We provide reference laboratory testing to various related and unrelated health care entities, managed care organizations and non-affiliated hospitals, outpatient clinics and private physicians' offices. In this role, the Revenue Integrity Specialist will improve compliant and accurate billing, and charge capture at the point of service at UChicago Medicine's (UCM) revenue cycle; to decrease costly back-end work and improve cash flow. Implement and promote consistent revenue integrity practices in regards to compliance in coding, billing, and proper documentation Optimize reimbursement working in partnership with departments to further develop the revenue stream and documentation processes.

Requirements

• High school diploma required.
• Associate or Bachelor's degree in a health-care information or health care finance related field preferred.
• Proven working knowledge of CPT (Current Procedural Terminology) and ICD (International Classification of Diseases) coding systems required, with auditing experience preferred.
• Knowledge of Federal billing regulations governing Medicare and Medicaid programs, and working knowledge of other managed care and indemnity (third party) payor requirements.
• Must possess a working knowledge of Local and National Coverage Determination policies (LCD's and NCD's), Ambulatory Payment Classification (APC) related edits such as the National Correct Coding Initiative (NCCI) and Outpatient Code Editor (OCE), and HIPAA (Health Information Portability & Accountability Act), regulations.
• Must be proficient in Microsoft Excel, Word, PowerPoint, and have some familiarity with Access.
• Must be highly analytical, and have excellent written and verbal communication skills.
• Must possess excellent organizational, time management and multi-tasking skills, along with demonstration of excellent interpersonal skills.
• Health Information Management or Coding certification required at the time of hire.

Responsibilities

• Analyzes and assists with correction of billing and coding errors identified by internal and vendor generated pre-billing edits designed to prevent claims delays & denials and non-compliant billing practices.
• Mitigate external audit risks via the practice of audits and continual educational efforts.
• Monitor detailed revenue volumes, Claim Edits, and late charges for the hospital, and provide real time notification to unusual variances.
• Advises regarding proper revenue cycle processes and workflows.
• Assists or advises departments regarding resolution of errors that prevent timely, accurate, and compliant claims submittal.
• Manage regulatory content, simplifying the complex reimbursement environment through promotion and support of consistent operational efficiencies.
• Help departments to maximize revenue when CPT codes for new technologies and services, or change in the payment rates for these and other established services occur.
• Conducts concurrent and retrospective audits of UCMC departments designed to focus on coding, billing, and documentation.
• Communicates findings back to department with re-audit and education as needed based off findings.
• Reviews revenue performance of UCM departments at the cost center and charge line item level, monitoring charge capture volume in units and dollars posted.
• Uses software such as Revenue Guardian to help identify revenue opportunities.
• Complete process improvement to identify issues in the revenue cycle and improve revenue cycle processes from first time billing to denials management.
• Identify regulatory changes that impact UCM departments who provide the service in question in order to reduce compliance risk for improper billing.
• Develops and conducts education tailored to needs of UCM departments such as infusion coding training.
• Analyzes top denial trends and implements plans to reduce future denials.

Benefits

• Comprehensive health insurance.
• 401k plan with matching.
• Paid time off and holidays.
• Flexible working hours.
• Tuition reimbursement.
• Employee wellness programs.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Industry: Educational Services
• Education Level: Associate degree