Revenue Integrity Specialist
hace 3 semanas
This position is responsible for overseeing revenue cycle operations for Department, with a focus on maximizing revenue through the implementation of recommended processes and functions in compliance with internal controls.
Main Responsibilities
- Review charge activity work queues and release charges from Epic to payers in compliance with Charge Description Master (CDM), with a focus on appropriate capture and reporting of revenue.
- Analyze, support, and follow up on complex revenue integrity initiatives.
- Provide subject matter expertise for insurance and assist front-end staff on insurance and organizational revenue integrity and charge capture policies and procedures.
- Coordinate new attending and fellow billing and coding training.
- Act as the single point of contact for billing compliance and insurance audit escalations, as well as annual billing and insurance plan updates.
- Provide subject matter expertise for contracting and pricing fee schedule updates, plan enrollment, and non-covered benefits.
Requirements
- High School Diploma / GED
- 5 years of experience within a hospital or healthcare billing setting
- Certified Professional Coder
- Knowledgeable in revenue cycle operations
- Familiar with insurance company processes and procedures
- Ability to work with key stakeholders to optimize revenue cycle operations
- Ability to train new staff with limited insurance knowledge on medical insurance
- System proficiency with Epic, Powerchart, QCC, 3rd party insurance company websites, and clearing houses
- Knowledgeable in Current Procedural Terminology, and ICD-10 diagnosis coding (CPC certification)
- Ability to work in a deadline-driven environment
- Ability to manage billing compliance for a department of 25 healthcare providers
- Ability to clearly communicate complex medical information both verbally and in writing
- Ability to work with families to understand bills and educate about medical billing while de-escalating complaints
- Knowledgeable in key performance indicators of revenue cycle such as accounts receivable and payer mix
Benefits
Boston Children's Hospital offers competitive compensation and unmatched benefits, including flexible schedules, affordable health, vision, and dental insurance, child care and student loan subsidies, generous levels of time off, 403(b) Retirement Savings plan, Pension, Tuition and certain License and Certification Reimbursement, cell phone plan discounts, and discounted rates on T-passes.
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