Revenue Integrity Specialist-(Audits & Denials) Revenue Integrity-Corporate 42nd Street- Full-Time- Days- Hybrid

Mount Sinai Health System•New York, NY

8d•Hybrid

About The Position

The Revenue Integrity Specialist for the Mount Sinai Health System (MSHS) and the Icahn School of Medicine at Mount Sinai (ISMMS) (which includes the MSHS and the Faculty Practice Plan) focuses on optimizing charge capture, reconciliation and process improvement for hospital-based revenue producing departments and the ambulatory sites. By fostering strong, collaborative relationships across the organization, this role will promote financial stewardship and facilitate bidirectional communication with clinical departments, providers, and key stakeholders. The Revenue Integrity Specialist will leverage their expertise in clinical workflows, revenue cycle management, and Epic to proactively identify and execute process improvements that enhance the system's financial health. This position reports to the Senior Manager of Revenue Integrity. The position requires the consistent exercise of independent professional judgment in interpreting, applying, and operationalizing complex clinical, regulatory, and reimbursement frameworks impacting revenue integrity.

Requirements

Bachelors degree in public health/administration, finance, business or a related field (clinical degree, RN, PT, OT, RT etc.,) or equivalent education and experience.
3-5 years working in a healthcare provider organization clinical department and/or 1-2 years working in a healthcare provider organization clinical department with 2 plus years’ experience in healthcare revenue cycle, revenue integrity, HIM or finance
Hospital and/or Professional Charge Experience
Epic experience preferred
Experience in one of the following areas Pharmacy, Hematology - Oncology, Laboratory and Pathology, Faculty Practices, Cardiology, Imaging, Rehabilitation or Hospital Based Services.
Coding certification, a plus.

Responsibilities

Ensure accurate charge capture, reconciliation, and compliance for all facility and professional services for designated service line.
Subject matter authority responsible for interpreting and applying charge methodology for services within designated service line.
Monitor charge baselines to identify variances, analyze causes of charge lag, and collaborating with key stakeholders implement workflow improvements to reduce late charges.
Subject matter authority and expert for the Charge Description Master (CDM/EAP), performing professional-level quality review and validation of additions, deletions, and revisions and ensures compliant charge code structures are available for all services within designated area.
Conducts independent revenue integrity analyses of clinical documentation and billing outputs, requiring interpretation of coding, reimbursement, and payer rules.
Perform chart to bill audits to ensure accurate charge, price and quantity, mitigating risks and ensuring compliance.
Analyze physician and service line charges to ensure compliance with payer regulations, methodologies, and managed care contract.
Coordinate special focus reviews, collaborating with compliance, patient access, and clinical departments.
Mitigate the risk of compliance violations, audits, and potential penalties related to charging errors.
Ensure compliance with all HIPAA privacy and security standards.
Independently designs, evaluates, and ensures implementation of revenue integrity workflows and controls, requiring application of professional judgment.
Develops, refines, and implements efficient processes and controls to optimize revenue integrity.
Collaborate with HIM, billing, IT, and clinical stakeholders to align workflows, resolve billing issues, and manage Epic work queues.
Exercises independent professional judgment to develop and refine the processes necessary to complete the work along with the ability to organize people and activities.
Provides interpretive guidance to clinical departments on reimbursement policy, coding updates, and charge capture requirements based on professional expertise.
Educate clinical departments on CPT updates, EAP changes, and new/expanded services.
Provides education to designated service lines on quarterly and end of year CPT updates and communicates any EAP updates/changes.
Establish and maintain strong working relationships with revenue cycle leaders, clinical leaders and staff, other key stakeholders, and foster a strong working relationship with key strategic partners.
Performs other duties as assigned