Revenue Integrity Specialist - Catholic Health

Catholic Health is one of Long Island’s finest health and human services agencies. Our health system has over 16,000 employees, six acute care hospitals, three nursing homes, a home health service, hospice and a network of physician practices across the island.

At Catholic Health, our primary focus is the way we treat and serve our communities. We work collaboratively to provide compassionate care and utilize evidence based practice to improve outcomes – to every patient, every time.

We are committed to caring for Long Island. Be a part of our team of healthcare heroes and discover why Catholic Health was named Long Island's Top Workplace!

The CHSLI Revenue Integrity Specialist works within the CHSLI Revenue Cycle Department under the direction of the AVP of Revenue Management and Integrity to ensure system wide revenue capture, reconciliation and timely processing of workque accounts by area of specialty.  The RIS is responsible for assessing, coordinating and managing the charge capture and reconciliation process for designated service area (s) from creation of the charge through and including a clean claim to improve revenue management and ensure the overall integrity of the charge capture process.

The RIS will work in collaboration with the revenue cycle and designated specialty departments to ensure charge capture for existing and new services consistent with governmental and non-governmental regulatory requirements. 

Duties and Responsibilities:

Below lists the anticipated job duties and responsibilities related to this position.  However, there may be additional job duties and responsibilities that you will be required to complete if the work is similar, related or is a logical assignment to the position.

Workques:

1. Reviews designated Epic workqueue’s, conducts research necessary to resolve the charge, account or claim issues and identifies revenue benefit expected from corrections.
2. Ensure timely completion of all WQ’s (charge, account and claim) owned by designated departments.
3. Completes accounts in designated WQ’s that the RIS is responsible for (Charge, Account and Claim).
4. Active engagement related to education with each of the designated departments with WQ issue resolvement.

Charges:

1. Ensures that all charges are captured within the designated Epic charge trigger, across the specialty area for all CHSLI hospitals, if applicable.
2. Identifies services that are reimbursable but not charged/coded, reviews, and validates revenue codes.
3. Perform periodic reviews and assessments of charge capture for specialty area assigned.
4. Responsible for educating and working with the specialty area clinical departments on compliant charging in relation to the Epic dynamic CDM, and charge development.
5. Coordinates/educates designated departments on EPIC Charge capture and reconciliation tool improvements.
6. Review CPT/HCPCS codes and completes research of any item in question for assigned service specialty area (s).
7. Performs daily analysis of designated service line fluctuations by entity and works to resolve with entity departmental leaders.
8. Provides ongoing monitoring of Epic reports and provides real time feedback to revenue cycle leadership, hospital finance leadership and specialty area leadership on any variations (positive or negative).
9. Reviews and assess late charges by entity and department.  Works towards resolution to eliminate late charges and escalate as needed.
10. Reviews Epic dashboard to oversee daily posted transactions and charge review workqueue productivity.
11. Provides education to departments on improving charging accuracy, optimizing compliant charge capture and completing documentation that allows for more accurate coding.
12. Provides updates and education to clinical specialty areas on CDM updates, and charge capture tools.

Misc:

1. Facilitates distribution and communication on payer updates to coding changes, as needed.
2. Identifies performance improvement opportunities across the specialty area.
3. Maintains working knowledge, and access to current charging and billing regulatory compliance guidelines.
4. Provides continuous monitoring of the established and approved process to ensure sustainability of established work processes. 
5. Engages and/or provide information (as requested) to CHSLI Finance and/or CHSLI Service Line Leaders as appropriate.
6. Develops and presents regulatory and compliance education to each facility clinical managers/directors.
7. Contributes to and consistently applies CHS services, policies, procedures and benefits to all customers and/or employees without discrimination.
8. Other duties as assigned as needed by the organization.

Position Requirements and Qualifications

Education: Bachelor’s Degree from an accredited college or university in Healthcare Administration, Business Administration, Finance or other related field. 

Experience:

Three (3) to five (5) years minimum experience in related healthcare field is required.  At least one year experience in acute care setting and/or revenue cycle operations preferred.

Experience with APC reimbursement, CMS rules and regulations, coding and billing compliance, preferred.

Experience with coding and Charge Master, preferred.

Experience working with Epic systems, and/or Epic Certifications (CDM and/or Revenue Integrity), preferred.

Certification: Certification in healthcare compliance (HCAA or AAPC’s certification) and/or Coding Certification (RHIA, RHIT, CPC or CCS) preferred.

Skills

*  Demonstrated ability to interpret, analyze, develop, direct and implement overall expectations as it relates to large     scale implementations and projects.

*  Ability to identify and redesign inefficient workflow and processes.

*  Proficiency with financial data with regards to charging, billing and reimbursement.

*  Possesses working knowledge of various payment and coding systems, particularly OPPS, HCPCS and CPT-4 coding   schemes.

*  Strong ability to lead and motivate.

*  Excellent written and verbal communication including the ability to resolve conflicts with tact and diplomacy.

*  Possess strong interpersonal skills in order to integrate and successfully function with all levels of the organization.

*  Self-directed with ability to work independently and manage time effectively.

*  Ability to analyze and interpret situations and information and offer guidance and quality decisions.

*  Superior analytical and problem solving skills.

Other Requirements:

1.  This is an exempt position requiring hours of work that may extend beyond the traditional work hours.
2.  Position requires travel between and within the CHSLI entities. 
3. Nature of work and duties requires ability to focus and greater attention to details, and exposure to stress greater than the average position.

This range serves as a good faith estimate and actual pay will encompass a number of factors, including a candidate’s qualifications, skills, competencies and experience. The salary range or rate listed does not include any bonuses/incentive, or other forms of compensation that may be applicable to this job and it does not include the value of benefits.

At Catholic Health, we believe in a people-first approach. In addition to the estimated base pay provided, Catholic Health offers generous benefits packages, generous tuition assistance, a defined benefit pension plan, and a culture that supports professional and educational growth.