Revenue Integrity Specialist

Scripps Health • San Diego, CA

11d • Remote

About The Position

The Revenue Integrity Specialists primary functions are daily management / resolution of revenue capture work queues (Account, Charge Review and Charge Router Review) that are designed to identify charge issues prior to billing and conducting quality and accuracy assessments of ancillary service area charge capture processes and clinical documentation for the care provided. Assessment includes review of the CPT/HCPCS codes associated with the procedural charges selected by the clinicians and coders, validation of the required documentation elements to support the services provided and charged, review of the charge capture processes including applicable charge sheets for supplies, medications, implants, procedures, validates accuracy and timeliness of charge entry. Provides timely feedback to ancillary care providers on quality and accuracy assessment. Able to evaluate and monitor coded diagnosis, coded procedures, and charges following National Correct Coding Guidelines, Medicare Integrated Code Editor, medical necessity, and regulatory billing guidelines. Identifies correct code and sequences the diagnoses and procedures using ICD-10-CM, CPT, HCPCS and modifier assigned on accounts.

Requirements

• High School graduate with completion of a certified coding program, or certified auditing program, or Associate's degree in health information technology.
• Demonstrates proficiency in use of ICD-10-CM, HCPCS, and CPT coding by successful completion of a written exam for outpatient Coder level II.
• Proficient in preparation and presentation of summary reports, education, and training power point presentations to focused groups and finance leadership.
• Minimum of one of one year experience required in an acute care hospital outpatient coding.
• Minimum of 1 year experience required in utilization of spreadsheets, graphics, power point, analytics and database applications.
• Certification/Registration: Registered Health Information Technician (RHIT), or Certified Coding Specialist (CCS), from American Health Information Management Association (AHIMA), or Certified Professional Coder (CPC) from American Academy of Professional Coders, or Certified Internal Auditor from Association of Healthcare Internal Auditors (AHIA), or Certified Medical Audit Specialist by American Association of Medical Audit Specialists (AAMAS).

Nice To Haves

• Minimum of 1 year experience preferred in the performance of charge quality assessments in an acute care hospital.
• Epic experience.
• Experience with focus audits, reports and coding.

Responsibilities

• daily management / resolution of revenue capture work queues
• conducting quality and accuracy assessments of ancillary service area charge capture processes and clinical documentation
• review of the CPT/HCPCS codes associated with the procedural charges selected by the clinicians and coders
• validation of the required documentation elements to support the services provided and charged
• review of the charge capture processes including applicable charge sheets for supplies, medications, implants, procedures, validates accuracy and timeliness of charge entry
• Provides timely feedback to ancillary care providers on quality and accuracy assessment
• Able to evaluate and monitor coded diagnosis, coded procedures, and charges following National Correct Coding Guidelines, Medicare Integrated Code Editor, medical necessity, and regulatory billing guidelines
• Identifies correct code and sequences the diagnoses and procedures using ICD-10-CM, CPT, HCPCS and modifier assigned on accounts

Benefits

• Nearly a quarter of our employees have been with Scripps Health for over 10 years.
• Scripps is a Great Place to Work Certified company for 2025.
• Scripps Health has been consistently ranked as a top employer for women, millennials, diversity, and as an overall workplace by various national publications.
• Becker’s Healthcare ranked Scripps Health on its 2024 list of 150 top places to work in health care.
• We have transitional and professional development programs to create a learning environment that enables you to thrive in your specific field as well as in your overall career.
• Our specialties have been nationally recognized for quality in areas such as cardiovascular care, oncology, orthopedics, geriatrics, obstetrics and gynecology, and gastroenterology.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED