Revenue Integrity Specialist

Houston Methodist•Houston, TX

About The Position

Revenue Integrity Specialist FLSA STATUS Non-exempt QUALIFICATIONS EDUCATION Associate’s degree or higher in billing, coding, accounting, or related field; or high school diploma with additional two years of related experience (in addition to the minimum experience requirements listed below) in lieu of college degree EXPERIENCE Three years of experience in patient accounting, revenue cycle, coding, or other related area SKILLS AND ABILITIES Demonstrates the skills and competencies necessary to safely perform the assigned job, determined through on-going skills, competency assessments, and performance evaluations Sufficient proficiency in speaking, reading, and writing the English language necessary to perform the essential functions of this job, especially with regard to activities impacting patient or employee safety or security Ability to effectively communicate with patients, physicians, family members and co-workers in a manner consistent with a customer service focus and application of positive language principles Familiarity with general International Classification of Disease (ICD) and Current Procedural Terminology (CPT) coding Knowledge of medical terminology Understanding of accreditation and government regulations (e.g., CMS) as applicable to scope of department Ability to be self-motivated and work independently with minimal supervision Proficient computer skills in Microsoft Office components, including Excel, and ability to learn and navigate multiple software programs Ability to think critically, analyze and solve problems Strong organizational skills Ability to handle detail work accurately and rapidly Ability to follow-through and handle multiple tasks simultaneously

Requirements

Associate’s degree or higher in billing, coding, accounting, or related field; or high school diploma with additional two years of related experience (in addition to the minimum experience requirements listed below) in lieu of college degree
Three years of experience in patient accounting, revenue cycle, coding, or other related area
Demonstrates the skills and competencies necessary to safely perform the assigned job, determined through on-going skills, competency assessments, and performance evaluations
Sufficient proficiency in speaking, reading, and writing the English language necessary to perform the essential functions of this job, especially with regard to activities impacting patient or employee safety or security
Ability to effectively communicate with patients, physicians, family members and co-workers in a manner consistent with a customer service focus and application of positive language principles
Familiarity with general International Classification of Disease (ICD) and Current Procedural Terminology (CPT) coding
Knowledge of medical terminology
Understanding of accreditation and government regulations (e.g., CMS) as applicable to scope of department
Ability to be self-motivated and work independently with minimal supervision
Proficient computer skills in Microsoft Office components, including Excel, and ability to learn and navigate multiple software programs
Ability to think critically, analyze and solve problems
Strong organizational skills
Ability to handle detail work accurately and rapidly
Ability to follow-through and handle multiple tasks simultaneously

Responsibilities

Promotes a positive work environment and contributes to a dynamic team focused work unit that actively helps one another to achieve optimal departmental and organizational results.
Develops, fosters and maintains a network of all organizational stakeholders involved in charge entry and processing to assist in the efficient resolution of charge reconciliation issues. Responds to questions regarding charge capture, serves as a subject matter expert in the area of charge capture, and trains/mentors others in related charge capture roles.
Performs data entry of clinical and/or operational information from worksheets and other data collection and reporting tools. Accurately enters all data into applicable databases ensuring timeliness and prevention of backlog. Identifies errors, performs problem solving, makes edits and updates records accordingly.
Handles work queues daily, organizes workflow, problem-solves, and manages multiple ongoing priorities with minimal supervision. Generates, copies, and distributes reports as directed by management.
Independently utilizes available resources to include electronic tools (e.g., electronic health records, spreadsheets, etc.) to gain understanding of process and edits in order to identify and resolve charge correction and/or registration issues.
Works daily with external and/or internal areas such as payors (where appropriate), information technology, registration, health information management, and/or billing to address edit issues that require specialized analysis; triages issues to appropriate department(s) to promote resolution identified.
Evaluates charges and validates accuracy. When inaccurate, makes revisions by adding, editing, and/or deleting inappropriate charges.
Identifies and corrects charging errors involving transfer of charges to correct accounts as appropriate.
Maintains current and accurate Charge Description Master (CDM) in accordance with coding regulations and guidelines and updates procedure codes as required.
Maintains strict confidentiality of patients, employees and hospital information at all times. Ensures protection of private health and personal information. Adheres to all Health Insurance Portability and Accountability Act (HIPAA) and Payment Card Industry (PCI) compliance regulations.
Ensures charges are audited, entered, and confirmed within timeframe set forth by Houston Methodist in order to meet Accounts Receivable (AR) Days metrics. Enters charges as required while closely adhering to system documentation.
Evaluates charges to ensure billing integrity and works with physicians and clinicians on documentation amendments as necessary to optimize reimbursement. Develops and implements charge reconciliation processes and tools for the clinical operations team to effectively use on the front end.
Monitors for trends and identification of missed revenue opportunities and areas for potential revenue enhancement.
Displays initiative to improve accuracy and timeliness of charge capture and documentation. Takes an active role in establishing consistency across respective stakeholders as changes in processes, tools, and overall practices are developed and implemented.
Keeps abreast of market and payor trends as they relate to the department. Actively engages in personal assessment and expands learning beyond baseline competencies with a focus on continual development (i.e., participates in training opportunities, focal point review activity, etc.). Applies new learning.