Revenue Integrity Specialist


HMH HOSPITALS CORPORATION Edison Requisition # 2021-97089 ShiftDay StatusFull Time with Benefits Weekend WorkNo Weekends Required HolidaysNo Holidays Required On CallNo On-Call Required Shift Hours8:30am - 5pm Address80 James Street, Edison, 08820

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Overview

How have you impacted someone’s life today? At Hackensack Meridian Health our teams are focused on changing the lives of our patients by providing the highest level of care each and every day. From our hospitals, rehab centers and occupational health teams to our long-term care centers and at-home care capabilities, our complete spectrum of services will allow you to apply your skills in multiple settings while building your career all within New Jersey’s premier healthcare system.

The Revenue Integrity Specialist works closely with clinical departments to ensure compliance with government, payer, and internal charge capture policies; provides coding and billing education to all effected departments clinical and non clinical departments. This position works with multi faceted software to manage clinical and financial department Charge Description Master (CDM). This position is also responsible for managing charge capture audit results, conducting root cause analysis, and taking corrective action. This position also acts as a resource to the Business Office and Health Information Services/Medical Record Departments in ICD-9 & HCPCS coding. Strong analytic background with ability to translate very technical information.

Responsibilities

A day in the life of a Revenue Integrity Specialist at Hackensack Meridian Health includes:

  • Performs chart reviews of clinical documentation as it pertains to coding, charging, DRG, and APC to ensure compliant reimbursement.
  • Researches and keeps current with all regulations, mandates, and guidelines all payors government and non government.
  • Executes post implementation audits to ensure that chargemaster changes result in appropriate reimbursement. This includes verifying reimbursement and coordinating the review of medical records, if needed to ensure that cost centers are processing charges appropriately.
  • Work with Patient Accounting to ensure denials and billing discrepancies related to coding and charge capture are addressed in a timely and accurate manner.
  • Proficient in using all coding, charge entry, billing, EMR and CDM software. (Clinical and Financial). 
  • Responsible for managing charge capture audit results, conducting root cause analysis, and taking corrective action. 
  • Works Bypass edits reports to ensure compliant accurate and optimal claim submission.
  • Corrects discrepancies in all effected computer systems to eliminate continuous rework.
  • Prepares educational tools and communicates systemic issues to Corporate Director for education back to departments. 
  • Acts as a coding and charging resource to all departments clinical and non clinical.
  • Assists in verifying rules and regulations mandated by all payors Government and non Government, Hospital/Technical and Physician/Professional.
  • Facilitates CDM requests with focus on regulatory mandates, coding compliance and adherence to internal guidelines regarding CDM maintenance, standard naming conventions, and pricing integrity.
  • Demonstrates a working Knowledge of local, state and federal regulatory requirements related to coding, charging, compliance while enhancing processes within all functional areas.
  • Attends training, performs research to keep current with Medicare, coding, and compliance guidelines as they pertain to coding, charge items, charge capture, and billing operations. Communicates regulatory changes in a timely manner to clinical and revenue cycle departments.
  • Leads projects to improve revenue compliance & efficiencies in the charge capture process, and CDM charge structure.
  • Develop, maintain, and implement revenue integrity related training materials Providing education to clinical and non clinical department teams regarding CPT codes, HCPCS codes, revenue codes, and modifiers and their compliant use ensuring revenue integrity.
  • Keeps current on coding and chargemaster related issues through monitoring of the regulatory environment review of literature, participation in professional organizations and continuing education. 
  • Demonstrates a knowledge of the direct relationship to the CDM and the interactions of other functional areas such as the General Ledger, cost accounting, cost reporting, and budget; clinical settings such as Laboratory, Radiology, Physical or Occupational Therapy, Respiratory Therapy, Cardiology, or Oncology.
  • Completes as needed specialize and ad hoc reports including data analysis.
  • Other duties and/or projects as assigned.
  • Adheres to HMH Organizational competencies and standards of behavior.

Qualifications

Education, Knowledge, Skills and Abilities Required: 

  • High School Diploma or Equivalency, Knowledge of Third-Party Requirements, Revenue Code Assignments, CPT, HCPCS, and ICD-9; DRG, and APC classification systems; medical terminology; billing and reimbursement processes. Preferred Certifications: CCS/CPC-H/.
  • Minimum of 5-10 Years Coding/Billing, and DRG experience, or progressively responsible and directly related work experience. 
  • PC Literate, HCS Hospital Billing System, Microsoft Office, Excel, Email, Word, Etc.

Licenses and Certifications Preferred: 

  • Certified Coding Specialist.
  • Certified Professional Coder.

If you feel that the above description speaks directly to your strengths and capabilities, then please apply today!

Our Network

As a courtesy to assist you in your job search, we would like to send your resume to other areas of our Hackensack Meridian Health network who may have current openings that fit your skills and experience.