Revenue Integrity Specialist

Job Summary :

Responsible for complete and accurate charge capture through review of medical record documentation of clinical services and procedures to ensure data integrity.

Performs charge reconciliation activity to ensure optimal charge capture in accordance with Medicare, Medicaid or Third Party payor guidelines.

Classification systems include ICD-9-CM, CPT, HCPCS as well as other specialty financial systems required for charging, billing and reimbursement analysis.

The Revenue Integrity Specialist may be a resource to coding, reimbursement, and departmental areas for questions related to charges, auditing and the charge master.

Duties and Responsibilities :

1. Obtains data extracts from specific system to support audit function. Validates data by researching anomalies and cross-referencing data with other systems.

2. The Revenue Integrity Analyst will analyze charge capture and reconciliation data and provide trending information on a monthly basis.

3. Assist with identification, reporting, analysis and resolution of information system problems.

4. Provides back-up resource for report analysis and account corrections. Maintains knowledge of reports by working collaboratively with Charge Services Director in completion of monthly reports.

5. Actively participates in team development, achieving department’s performance indicators and in accomplishing goals and objectives.

Requirements :

Bachelor’s Degree in Business Administration or Healthcare Finance Required, Master’s Degree Preferred.

Must have at least 5 years of hospital and finance work experience.

Quantitative and financial analysis skills; time management skills with ability to prioritize projects to meet deadlines.

Competent in Microsoft office suite applications.

Claims processing, database management, and statistical analysis skills preferred.

Care New England Health System (CNE) and its member institutions, Butler Hospital, Women & Infants Hospital, Kent Hospital, VNA of Care New England, Integra, The Providence Center, and Care New England Medical Group, and our Wellness Center, are trusted organizations fueling the latest advances in medical research, attracting the nation’s top specialty-trained doctors, and honing renowned services and innovative programs to engage in the important discussions people need to have about their health.

Americans with Disability Act Statement : External and internal applicants, as well as position incumbents who become disabled must be able to perform the essential job-specific functions either unaided or with the assistance of a reasonable accommodation, to be determined by the organization on a case-by-case basis.

EEOC Statement : Care New England is an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status

Ethics Statement : Employee conducts himself / herself consistent with the ethical standards of the organization including, but not limited to hospital policy, mission, vision, and values.