Senior 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 Catholic Health Senior Revenue Integrity Specialist works within the Hospital Revenue Cycle Department under the direction of the AVP of Revenue Management and Integrity to ensure revenue capture and activities which assist the hospital with processes for complete and accurate capture of documentation and charges for services rendered.

The Senior Revenue Integrity Specialist provides assistance with processes and education within the Clinical Departments to support accurate documentation and charging in compliance with organizational policies. The Senior Revenue Integrity Specialist assists clinical areas to effectively document services and understand the relationship between documentation, medical necessity, coding and charging for all services provided. The Senior Revenue Integrity Specialist provides education and training of staff on clinical documentation, coding and charging for facility services. In addition, the Senior Revenue Integrity Specialist will serve as a resource and support the department’s revenue integrity specialists.

Essential 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.

1. Conduct chart reviews of Clinical departments to regularly review the documentation and charge accuracy integrating findings into educational sessions with the Clinical departments and medical staff.
2. Performs shadowing and coaching with key stakeholders in the Clinical departments to facilitate adoption of best practices and improve documentation and charging accuracy.
3. Takes ownership and initiative to build upon documentation improvement and charge capture processes for identified areas of opportunity.
4. Provides reporting and feedback to the Clinical Departments based on claim accuracy and chart reviews to encourage greater understanding and ownership of documentation and charge accuracy.
5. Performs review of accounts identified as potentially missing charges and conducts additional research to help resolve the areas of opportunity and identify the root cause of the issues causing the missed charges.
6. Coordinates with clinical departments including Coding, PFS, CDM, Finance and others to review, correct claims and identify root cause of missing charges.
7. Performs analysis of patient clinical and billing data to identify documentation, coding and charging opportunities, summarizes data and prepares summary materials for discussion with clinical and finance teams
8. Maintains current knowledge of applicable regulatory standards, which may impact utilization of processes and systems

1. Work with finance to track revenue indicators and corresponding action plans.
2. Performs revenue optimization functions including:
   1. Review of accounts for potential missing documentation, coding and charging
   2. Identify root cause of missing charges
   3. Educate Clinical and Ancillary Departments
   4. Perform process improvement activities aimed at revenue optimization
   5. Coordinate with the Clinical Departments, Coding, CDM, and other key stakeholders to address and resolve root cause issues
3. Provide education and mentoring on topics related to revenue integrity and regulatory changes for the revenue integrity specialists
4. Review CPT/HCPCS codes and completes research of any item in question for assigned service specialty area (s).
5. Reviews designated Epic workqueue’s, conducts research necessary to resolve the account issues and identifies revenue benefit expected from all account corrections.
6. Facilitates distribution and communication on payer updates to coding changes, as needed.
7. Maintains working knowledge, and access to current charging and billing regulatory compliance guidelines.
8. Provides continuous monitoring of the established and approved process to ensure sustainability of established work processes.
9. Develops and presents regulatory and compliance education to each facility clinical managers/directors.

1. Fosters teamwork and utilizes strong team building measures.
2. Develops and maintains project plans and project tracking, including documentation of project meetings and project issues lists.
3. Contributes to and consistently applies CHS services, policies, procedures and benefits to all customers and/or employees without discrimination.

Position Requirements and Qualifications

Knowledge, Skills and Abilities

Education: Bachelor’s Degree from an accredited college or university.

Licensure/Certification: RN, LPN, licensure within the allied health field or RHIA, RHIT, COC, or CDEO credential.

Experience:

• Five (5) years minimum experience in related healthcare field is required.  Experience with outpatient and inpatient services preferred.
• Three or more years of healthcare knowledge typically obtained from experience as a clinical caregiver or manager, coding specialist, and/or a revenue management/cycle professional staff person
• Knowledge of 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, 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.