Veterans in Healthcare
Senior Revenue Integrity Specialist - Clinical Rev Integrity
Veterans in Healthcare, Los Angeles, California, United States, 90079
Senior Revenue Integrity Specialist - Clinical Rev Integrity
3 days ago Be among the first 25 applicants
Senior Revenue Integrity Specialist provides leadership to the daily CDM maintenance workflow between the various entities of Keck Medical Center of USC and monitors the alignment of the entities to the standard policy for maintaining the CDM. The RI Specialist ensures the timely and accurate synchronization of data between the CDM residing in the billing system and CDM management tools. The Senior RI Specialist ensures that the Chargemaster (CDM) is consistent with all coding and billing regulations and accurately represents services provided, including annual updates required by Medicare and other third‑party payers. The role also involves directing documentation of policies and procedures regarding CDM maintenance and charge processes, conducting meetings to evaluate department charge processes, and coordinating with Keck Medical Center of USC Administration, IS, Compliance, Clinical Informatics and Integration personnel on technology projects impacting charge entry and dictionaries.
Essential Duties
Perform maintenance on the Keck Medical Center of USC Charge Description Master, ensuring annual updates required by Medicare and other third‑party payers are current.
Review and process requests for new code additions, code set corrections, revenue code to CPT/HCPCS code mismatch corrections, and ongoing identified changes for current systems to maintain compliance with state and federal regulatory agencies.
Lead and conduct meetings with Operations Leaders, Revenue Auditors, Clinical Department Staff, and Gatekeepers to address compliance issues.
Serve as a subject matter expert for projects impacting revenue integrity and CDM, and communicate with stakeholders.
Take the lead on projects with broad organizational impact, exercising significant judgment and discretion.
Coordinate and lead the Revenue/Chart Audit team in research and resolution of account issues related to CDM and charge capture.
Synchronize CDM data between CDM and CDM Workflow & Management Tool on a monthly basis.
Import/extract data from various sources in various formats for review, monitoring, tracking, and maintaining CDM integrity.
Provide CDM data via ad‑hoc reports as needed.
Guide and educate on ensuring CDM and charge capture standards for new entities (e.g., Verdugo Hills) align with Keck policies.
Perform charge reconciliation, industry best practice research, and deploy charge capture improvement initiatives.
Interpret and explain details of charge services as needed.
Collaborate with Revenue Cycle and Ancillary teams in developing education programs for USC Administration, Managers and Staff on charge master and capture topics.
Participate in development of policies, procedures, monitoring tools for late charges, and procedures for timely charge capture.
Enhance professional growth and contribute to dashboards and team goals.
Perform other duties as assigned.
Required Qualifications
Associate’s Degree in Business Administration, Accounting, Finance, Healthcare Administration, Nursing or similar field.
Certification from an accredited program of Certified Coder (CPC/CCS/COC) or Certificate of Auditing (CPMA) within one year from date of hire.
5 years experience in healthcare; experience may include clinical service delivery, coding, provider billing, medical records, charge audit, CDM maintenance, Medicare/Medicaid reimbursement, managed care contracts, and patient accounting.
Experience with inpatient and outpatient billing requirements (UB‑04) and CMS Medicare reimbursement methodology.
Knowledge of other government and third‑party payer reimbursement methodology.
Ability to implement a systematic, self‑motivated approach to problem solving and coordinate resources to execute plans.
Proficiency in MS Office and Windows.
Preferred Qualifications
Bachelor’s Degree in Business Administration, Accounting, Finance, Healthcare Administration, Nursing or related field.
Experience and knowledge of hospital charging practices.
Healthcare operations experience, particularly in an acute care hospital setting.
Current knowledge of the revenue cycle, flow of charges in and across hospital billing systems.
Previous hospital Chargemaster experience, including CDM maintenance software (Craneware or Med Assets).
Working knowledge of CPT, HCPCS and ICD‑9 coding principles.
Knowledge of software: Cerner and Craneware.
Registered Nurse (RN) - CA Board of Registered Nursing.
Pharmacy Technician (CA DCA).
Required Licenses/Certifications
Specialty Certification Certified Coder (CCS or CPC), Certified Outpatient Coder-COC (AAPC) or Certified Auditor (CPMA) obtained within one (1) year of date of hire.
Fire Life Safety Training (LA City). Must be obtained within 30 days of hire if not already held.
The annual base salary range for this position is $95,680.00 – $158,230.00. When extending an offer of employment, the University of Southern California considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate’s work experience, education/training, key skills, internal peer equity, federal, state, and local laws, contractual stipulations, grant funding, as well as external market and organizational considerations.
REQ20168561 posted 10/30/2025. Apply.
#J-18808-Ljbffr
Senior Revenue Integrity Specialist provides leadership to the daily CDM maintenance workflow between the various entities of Keck Medical Center of USC and monitors the alignment of the entities to the standard policy for maintaining the CDM. The RI Specialist ensures the timely and accurate synchronization of data between the CDM residing in the billing system and CDM management tools. The Senior RI Specialist ensures that the Chargemaster (CDM) is consistent with all coding and billing regulations and accurately represents services provided, including annual updates required by Medicare and other third‑party payers. The role also involves directing documentation of policies and procedures regarding CDM maintenance and charge processes, conducting meetings to evaluate department charge processes, and coordinating with Keck Medical Center of USC Administration, IS, Compliance, Clinical Informatics and Integration personnel on technology projects impacting charge entry and dictionaries.
Essential Duties
Perform maintenance on the Keck Medical Center of USC Charge Description Master, ensuring annual updates required by Medicare and other third‑party payers are current.
Review and process requests for new code additions, code set corrections, revenue code to CPT/HCPCS code mismatch corrections, and ongoing identified changes for current systems to maintain compliance with state and federal regulatory agencies.
Lead and conduct meetings with Operations Leaders, Revenue Auditors, Clinical Department Staff, and Gatekeepers to address compliance issues.
Serve as a subject matter expert for projects impacting revenue integrity and CDM, and communicate with stakeholders.
Take the lead on projects with broad organizational impact, exercising significant judgment and discretion.
Coordinate and lead the Revenue/Chart Audit team in research and resolution of account issues related to CDM and charge capture.
Synchronize CDM data between CDM and CDM Workflow & Management Tool on a monthly basis.
Import/extract data from various sources in various formats for review, monitoring, tracking, and maintaining CDM integrity.
Provide CDM data via ad‑hoc reports as needed.
Guide and educate on ensuring CDM and charge capture standards for new entities (e.g., Verdugo Hills) align with Keck policies.
Perform charge reconciliation, industry best practice research, and deploy charge capture improvement initiatives.
Interpret and explain details of charge services as needed.
Collaborate with Revenue Cycle and Ancillary teams in developing education programs for USC Administration, Managers and Staff on charge master and capture topics.
Participate in development of policies, procedures, monitoring tools for late charges, and procedures for timely charge capture.
Enhance professional growth and contribute to dashboards and team goals.
Perform other duties as assigned.
Required Qualifications
Associate’s Degree in Business Administration, Accounting, Finance, Healthcare Administration, Nursing or similar field.
Certification from an accredited program of Certified Coder (CPC/CCS/COC) or Certificate of Auditing (CPMA) within one year from date of hire.
5 years experience in healthcare; experience may include clinical service delivery, coding, provider billing, medical records, charge audit, CDM maintenance, Medicare/Medicaid reimbursement, managed care contracts, and patient accounting.
Experience with inpatient and outpatient billing requirements (UB‑04) and CMS Medicare reimbursement methodology.
Knowledge of other government and third‑party payer reimbursement methodology.
Ability to implement a systematic, self‑motivated approach to problem solving and coordinate resources to execute plans.
Proficiency in MS Office and Windows.
Preferred Qualifications
Bachelor’s Degree in Business Administration, Accounting, Finance, Healthcare Administration, Nursing or related field.
Experience and knowledge of hospital charging practices.
Healthcare operations experience, particularly in an acute care hospital setting.
Current knowledge of the revenue cycle, flow of charges in and across hospital billing systems.
Previous hospital Chargemaster experience, including CDM maintenance software (Craneware or Med Assets).
Working knowledge of CPT, HCPCS and ICD‑9 coding principles.
Knowledge of software: Cerner and Craneware.
Registered Nurse (RN) - CA Board of Registered Nursing.
Pharmacy Technician (CA DCA).
Required Licenses/Certifications
Specialty Certification Certified Coder (CCS or CPC), Certified Outpatient Coder-COC (AAPC) or Certified Auditor (CPMA) obtained within one (1) year of date of hire.
Fire Life Safety Training (LA City). Must be obtained within 30 days of hire if not already held.
The annual base salary range for this position is $95,680.00 – $158,230.00. When extending an offer of employment, the University of Southern California considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate’s work experience, education/training, key skills, internal peer equity, federal, state, and local laws, contractual stipulations, grant funding, as well as external market and organizational considerations.
REQ20168561 posted 10/30/2025. Apply.
#J-18808-Ljbffr