Revenue Integrity Specialist | Beth Israel Deaconess Medical Center Boston, MA, US

Job Details:
Job Summary:The Revenue Integrity Specialist utilizes department reporting and works with team resources to both ascertain charge system/ process quality and identify weaknesses, for the purpose of recommending changes, improvements and focused education.
The Specialist works collaboratively within the Revenue Integrity team to determine the best practice approach to produce resolutions, and implement solutions that support more efficient and effective work performance based inherent knowledge of business processes.
Using a cooperative approach, the Specialist plans and coordinates the related implementations and delivers the education needed to apply the change/s within each impacted department.
Essential Responsibilities:
1.Analyzes weekly charge reconciliation report in order to verify that depts capture all charges; compile findings in dept charge capture performance reports. Review dept's chart documentation to verify that medical record documentation supports the charges billed, prepares a summary report of findings and meets with dept leadership to review documentation standards/recommendations for improvement.
2.Analyzes charge capture audit reports to verify that appropriate charges have been posted to patient accounts according to diagnosis and related procedure codes.
3.Identifies any charge trends and utilizes this information to determine quarterly focused reviews of specific departments. Provides additional education determined by findings.
4.Serves as a regulatory resource of Medicare, Medicaid, Medicaid OPPS reimbursement and other 3rd party billing rules and coverage through self-directed education and communication to departments.
5.Works/communicates with CDM Coordinator regarding Medicare and other regulatory updates in order to educate departments and up CDM accordingly on a quarterly basis.Required Qualifications:
1.High School diploma or GED required. Bachelor's degree preferred.
2.Certificate 1 Certified Professional Coder required., or Certificate 2 CCS Physician-based required.
3.3-5 years related work experience required.
4.In depth knowledge of CPT/HCPCS coding. Understanding of multiple reimbursement systems including IPPS, OPPS and fee schedule.
5.Experience in auditing, training, communication of regulations and concepts.
6.Advanced skills with Microsoft applications which may include Outlook, Word, Excel, PowerPoint or Access and other web-based applications. May produce complex documents, perform analysis and maintain databases.Preferred Qualifications:
1.Nursing experience preferred.Competencies:
1.Written Communications:Ability to communicate clearly and effectively in written English with internal and external customers...
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