Revenue Integrity Specialist

Planned Parenthood of Illinois • Chicago, IL

91d • $29 - $29

About The Position

The Revenue Integrity Specialist plays a critical role within the Revenue Cycle team by ensuring accurate and timely charge capture, billing, and reimbursement for clinical services. This position is responsible for analyzing charge data, resolving EPIC suspended edits, and maintaining the non-systems Revenue Cycle Charge Master. Through collaboration with clinical, IT, and financial departments, the Specialist ensures that all services documented in clinical records are properly captured and billed in compliance with state, federal, and payer regulations.

Requirements

• High School Diploma or GED
• Certification in Coding
• Strong knowledge of Commercial, Medicaid/MCO Insurances
• Knowledge of CPT, HCPCS, and Revenue Codes
• Knowledge of revenue cycle workflow processes and professional medical billing
• Familiarity with government and managed care reimbursement methodologies
• Ability to research payer requirements and policies
• Knowledge of NCCI edits, LCDs/NCDs
• 3+ years revenue cycle experience including, but not limited to, revenue integrity, billing, coding, denials, and patient account management
• Technology skills must include expertise in the use of spreadsheet software and electronic records systems

Nice To Haves

• Associate’s degree or equivalent combination of experience and education preferred
• At least one year of experience working within EPIC as an end user is preferred
• Project management and database management skills desired

Responsibilities

• Research billing and coding regulations to ensure organizational compliance
• Communicate and submit the necessary documentation and technical data that the Business Operations Technology (BOT) team needs to make necessary changes that impact policy, financial, charge capture, billing, and coding operations
• Perform daily maintenance and quarterly audits of the charge master to ensure up-to-date coding and encounter pricing is maintained for billing accuracy
• Liaison with Revenue Cycle, IT and clinical departments to ensure updates to the charge master
• Responsible for the submission and follow-up of new service codes and deactivation of outdated service codes and pricing to ensure state, federal and payer billing compliance
• Work with purchasing to ensure that the correct annual and quarterly 340B pricing is maintained
• Maintain current knowledge of Charge Description Master (CDM), Charge Preference List (CPL), and Flowsheet Charging to provide revenue cycle support
• Follow up with Health Center staff to ensure all services are entered into the patient accounting system
• Work with the Health Centers if system downtime and outages are encountered to ensure that clinical documentation and charges are entered timely for billing
• Audit charges captured by clinical departments for accuracy and completeness. Ensures that charges are crossing to the bill as intended for RCM Vendor submissions
• Troubleshoot charge posting issues. Identify charging opportunities. Manage assigned EPIC work queues
• Responsible for reviewing and resolving all pre-bill suspended charge edits daily to ensure timely system claims data info crossover to the RCM billing vendor for submission to the payer
• Assist patients with billing questions and concerns
• Maintain lab vendors portal on missing or updated information needed for laboratory work
• Audit post-visit charge coding and clinical data to ensure that the appropriate billing service codes are consistently appended prior to submission to the billing vendor to ensure OIG, state, federal and payer compliance
• Identify charge capture opportunities (missed billing, over-charging, under-charging) or compliance issues in revenue-producing departments and assist with the interdepartmental implementation of process improvements
• Contribute to organizational improvement initiatives directed by department leaders, focusing on exceeding the RCM KPIs for performance metrics
• Analyze internal credit balance, automated system, and manual vendor contractual adjustment data methodologies daily to assist with identifying and resolving patient accounting inaccuracies before the month end close
• Actively participate in team development, achieving dashboards, and in accomplishing departmental goals and objectives
• Maintain up-to-date and current knowledge of charge capture workflows and proactively maintain and increase knowledge of professional coding and revenue integrity compliance through on-going, self-started professional development
• Demonstrate an understanding of and commitment to remain informed about PPIL protocols, policies, and procedures
• Demonstrate an understanding of and commitment to PPIL core values of access, activism, care, confidentiality, diversity, excellence, integrity, respect, self-determination, and stewardship; practice these values in relations with internal and external customers
• Other duties and special projects as assigned

Benefits

• Company subsidized premiums on Medical, Dental, and Vision Insurance
• Up to 12 weeks Paid Parental Leave for eligible employees
• Generous Paid Time Off (PTO) and paid holidays
• Mission focused work
• 401k with employer matching
• 100% company-paid Life Insurance
• 100% company-paid Short- and Long-Term Disability Coverage
• Robust Employee Assistance Program
• Professional Development awards and opportunities
• Flexible Spending Accounts
• Free Medical Services at PPIL
• Pet Insurance

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED
• Number of Employees: 501-1,000 employees