REVENUE INTEGRITY SPECIALIST SENIOR
Job posting number: #7088042 (Ref:hlj_31998)
Posted: October 28, 2021
Application Deadline: Open Until Filled
The Revenue Integrity Senior Support Specialist ensures a consistent charge capture and billing to promote optimal reimbursement by applying appropriate management of Code Correct initiative (CCI)/Outpatient Code Editor (OCE) edits in a timely fashion, coordinating efforts with other areas in the revenue cycle and clinical areas and analyzing the impact of coding changes.
- Master’s Degree in Nursing, Finance, HIM/Coding, Healthcare or Business Administration
- Cerner and Soarian experience
- Coding and Charge Description Master (CDM) maintenance experience
Education and Credentials:
- Bachelor’s Degree in Nursing, Finance, HIM/Coding, Healthcare or Business Administration
- A minimum of four (4) years experience in clinical (nursing or allied health), coding, provider billing, medical records, charge audit environment, Medicare/Medicaid reimbursement, managed care contractual arrangements, and patient accounting.
- In lieu of bachelor’s degree, a high school diploma or equivalent and additional five (5) years of relevant experience will be considered
- One of the following certifications: Certified Professional Coder (“CPC”), Certified Professional Coder – Hospital (“CPC-H”), Certified Coding Specialist (“CSS”), Certified Coding Specialist – Physician-based (“CSSP”), Radiation Oncology Coder (“ROCC”), Certified Interventional Radiology Coder (“CIRCC”) or any certification sponsored by the American Academy of Professional Coders (“AAPC”), Registered Health Information Administrator (“RHIA”), and other accredited coding certifications may be considered, or RN (Registered Nurse) licensure.
• Reviews Correct Coding Initiatives (CCI)/Outpatient Code Editor (OCE) edits for trending analysis and charge capture opportunities
• Reviews and completes coding for complex edits
• Analyzes correlation between coding edits and departmental monthly charge reports
• Review and quantify impact of coding changes before and after implementation
• Supports timely resolution of issues related to billing, denials and charge capture
• Maintains the Master Transaction Catalog (Charges, Service Catalog and Revenue Service Map) in current Financial System
- Identify missing/inaccurate charge codes for clinical area of responsibility
• Works with Manager to optimize process for charge codes updates (add, inactivate)
• Analyzes root cause of issues related to edits for automation opportunities
• Works with clinical staff and revenue cycle departments to proactively develop charge codes for new procedures
• Provides assistance on special projects as assigned
• Participates on training and educational initiatives regarding clinical documentation to support charge
• Demonstrated ability to interpret, analyze, develop, direct and implement action to comply with proposed or final Medicare regulations
• Proficiency with financial data with billing and reimbursement related experience
• Understands financial management and health care reporting, including the relationship between the Charge Description Master (CDM), charging and cost reporting
• Demonstrates knowledge of the charge development process and the interrelationship of cost accounting, cost management, decision support and related functions
• Possesses a working knowledge of various payment and coding systems, particularly the Outpatient Prospective Payment System (OPPS), and Healthcare Common Procedure Coding System (HCPCS) and Current Procedural Terminology (CPT) coding schemes
• Possesses a working knowledge of hospital and professional claims forms
• Understands charging processes and compliance issues and has the ability to provide resolutions by performing internet research, utilizing third party payor regulations, referencing coding guidelines, and referencing local Fiscal Intermediary and Center of Medicare and Medicare guidelines Page 5 of 10 September 21, 2018
Mission To create a Moffitt culture of diversity and inclusion as we strive to contribute to the prevention and cure of cancer. Vision Moffitt Cancer Center is recognized as the model wherein the diversity of our employees and communities is valued and supported as essential components to contributing to the prevention and cure of cancer. The cancer center is an equal opportunity employer. It is the policy of the cancer center to prohibit unlawful discrimination and harassment of any type and to afford equal employment opportunities to workforce members and applicants, regardless of race, color, religion, sex, sexual orientation, gender identity or expression, national origin, age, marital status, disability, genetic information, veteran’s status or any other characteristic protected by federal, state or local law.