Keck Medicine of USC
Senior, Revenue Integrity Specialist - Clinical Revenue Integrity - Full Time 8
Keck Medicine of USC, Los Angeles, California, United States, 90079
Overview
Senior, Revenue Integrity Specialist - Clinical Revenue Integrity - Full Time 8 Hour Days (Exempt) (Non-Union) at Keck Medicine of USC. The RI Specialist provides leadership for the daily CDM maintenance workflow across Keck Medical Center of USC, ensuring the Chargemaster (CDM) aligns with coding and billing regulations and is up to date with annual updates required by Medicare and other third-party payers. Responsibilities
Perform maintenance of the Keck Medical Center of USC Charge Description Master (Keck & Norris) and assist the Revenue Cycle in annual coding reviews and updates. Review and process requests for new code additions, code set corrections, and corrections for revenue code to CPT/HCPCS mismatches to maintain regulatory compliance. Lead meetings with Operations Leaders, Revenue Auditors, Clinical Department Staff, and Gatekeepers to address compliance with government regulations, third-party payer needs, and industry standards. Serve as subject matter expert for projects impacting revenue integrity and CDM; communicate with stakeholders as needed. Provide leadership on projects with broad organizational impact and supervise the Revenue/Chart Audit team in researching and resolving CDM-related issues. Synchronize CDM data between CDM and CDM Workflow/Management Tool for Keck entities on a monthly basis. Import/export data from various sources to review, monitor, and maintain CDM integrity and charge capture processes. Provide CDM data in ad-hoc reports as needed and educate clinical revenue generating departments on CDM maintenance, coding updates, compliance, and charge capture improvements. Perform charge reconciliation, industry best-practice research, and deploy charge capture improvement initiatives. Interpret and explain details of charge services; collaborate with Revenue Cycle and Ancillary teams on education programs for USC Administration, Managers, and Staff on CDM, charge capture, and related processes. Contribute to policy development, monitoring tools for late charges, and procedures for timely and accurate charge capture. Participate in team development, dashboard creation, and achievement of departmental and organizational goals. Perform other duties as assigned. Required Qualifications
Associate’s Degree in Business Administration, Accounting, Finance, Healthcare Administration, or Nursing. Specialized/technical training with Certification from an accredited program (CPC/CCS/COC) or Certificate of Auditing (CPMA) within one year of hire. 5 years of experience in healthcare, from a mix of clinical services, coding, billing, medical records, CDM maintenance, Medicare/Medicaid reimbursement, and related areas. Experience with inpatient and outpatient billing requirements (UB-04) and CMS Medicare reimbursement methodology. Knowledge of government and third-party payer reimbursement methodologies. Ability to implement a systematic, self-motivated approach to problem solving and coordinate resources to execute plans. Proficient skills in MS Office/Windows. Preferred Qualifications
Bachelor’s Degree in Business Administration, Accounting, Finance, Healthcare Administration, or Nursing. Experience in hospital Chargemaster and CDM maintenance software (e.g., Craneware or MedAssets). Experience with hospital charging practices and healthcare operations in an acute care setting. Knowledge of Revenue Cycle flow across hospital billing systems; familiarity with CPT, HCPCS, and ICD-9 coding principles. Working knowledge of Cerner and Craneware. Registered Nurse (CA Board of Registered Nursing) or Pharmacy Technician (CA DCA) licensure/certification. Required Licenses/Certifications
CCS or CPC, Certified Outpatient Coder-COC (AAPC), or CPMA certification within one year of date of hire. Fire Life Safety Training (LA City) or obtain within 30 days of hire and maintain renewal; applicable in LA City only. The annual base salary range for this position is $95,680.00 - $158,230.00. USC considers factors such as job scope, experience, education, skills, internal equity, and market conditions when extending offers.
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Senior, Revenue Integrity Specialist - Clinical Revenue Integrity - Full Time 8 Hour Days (Exempt) (Non-Union) at Keck Medicine of USC. The RI Specialist provides leadership for the daily CDM maintenance workflow across Keck Medical Center of USC, ensuring the Chargemaster (CDM) aligns with coding and billing regulations and is up to date with annual updates required by Medicare and other third-party payers. Responsibilities
Perform maintenance of the Keck Medical Center of USC Charge Description Master (Keck & Norris) and assist the Revenue Cycle in annual coding reviews and updates. Review and process requests for new code additions, code set corrections, and corrections for revenue code to CPT/HCPCS mismatches to maintain regulatory compliance. Lead meetings with Operations Leaders, Revenue Auditors, Clinical Department Staff, and Gatekeepers to address compliance with government regulations, third-party payer needs, and industry standards. Serve as subject matter expert for projects impacting revenue integrity and CDM; communicate with stakeholders as needed. Provide leadership on projects with broad organizational impact and supervise the Revenue/Chart Audit team in researching and resolving CDM-related issues. Synchronize CDM data between CDM and CDM Workflow/Management Tool for Keck entities on a monthly basis. Import/export data from various sources to review, monitor, and maintain CDM integrity and charge capture processes. Provide CDM data in ad-hoc reports as needed and educate clinical revenue generating departments on CDM maintenance, coding updates, compliance, and charge capture improvements. Perform charge reconciliation, industry best-practice research, and deploy charge capture improvement initiatives. Interpret and explain details of charge services; collaborate with Revenue Cycle and Ancillary teams on education programs for USC Administration, Managers, and Staff on CDM, charge capture, and related processes. Contribute to policy development, monitoring tools for late charges, and procedures for timely and accurate charge capture. Participate in team development, dashboard creation, and achievement of departmental and organizational goals. Perform other duties as assigned. Required Qualifications
Associate’s Degree in Business Administration, Accounting, Finance, Healthcare Administration, or Nursing. Specialized/technical training with Certification from an accredited program (CPC/CCS/COC) or Certificate of Auditing (CPMA) within one year of hire. 5 years of experience in healthcare, from a mix of clinical services, coding, billing, medical records, CDM maintenance, Medicare/Medicaid reimbursement, and related areas. Experience with inpatient and outpatient billing requirements (UB-04) and CMS Medicare reimbursement methodology. Knowledge of government and third-party payer reimbursement methodologies. Ability to implement a systematic, self-motivated approach to problem solving and coordinate resources to execute plans. Proficient skills in MS Office/Windows. Preferred Qualifications
Bachelor’s Degree in Business Administration, Accounting, Finance, Healthcare Administration, or Nursing. Experience in hospital Chargemaster and CDM maintenance software (e.g., Craneware or MedAssets). Experience with hospital charging practices and healthcare operations in an acute care setting. Knowledge of Revenue Cycle flow across hospital billing systems; familiarity with CPT, HCPCS, and ICD-9 coding principles. Working knowledge of Cerner and Craneware. Registered Nurse (CA Board of Registered Nursing) or Pharmacy Technician (CA DCA) licensure/certification. Required Licenses/Certifications
CCS or CPC, Certified Outpatient Coder-COC (AAPC), or CPMA certification within one year of date of hire. Fire Life Safety Training (LA City) or obtain within 30 days of hire and maintain renewal; applicable in LA City only. The annual base salary range for this position is $95,680.00 - $158,230.00. USC considers factors such as job scope, experience, education, skills, internal equity, and market conditions when extending offers.
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