GENERAL SUMMARY:

The Revenue Integrity Specialist position identifies revenue opportunities and works collaboratively with Revenue Cycle staff to drive process improvement, educate clinical departmental staff, and document workflows. Primary areas of focus include increased revenue capture, compliance, and decreased denials.

PRINCIPLE DUTIES AND RESPONSIBILITIES:

1. Actively participates in team development, achieving financial targets, and accomplishing department goals and objectives.

2. Analyzes charge reconciliation reports to verify that departments have captured all charges, and compile findings in departmental charge capture performance reports.

3. Identifies charge trends and utilizes this information to determine quarterly focused reviews of specific departments.

4. Provides additional education determined by findings.

5. Coordinates with the RI Auditor to review provider/clinician documentation to verify that the medical record supports the charges billed, prepares a summary report of findings, and shares with departmental leadership.

6. Coordinates with RI Auditor to review accounts comparing the medical record and itemized bill to identify charging and billing weaknesses in the system.

7. Coordinates with CDM Manager regarding Medicare and other regulatory updates to provide education to departments and update CDM accordingly.

8. Works with CBO (Denials, Billing and third Party) to identify issues related to denied charges for hospital services, and coordinates with CDM Manager to update CDM accordingly.

9. Meets with clinical departments and specialties to ensure appropriate charge capture for services provided.

10.Serves as a regulatory resource of Medicare, Medicaid, Medicaid OPPS reimbursement and other third-party billing rules and coverage through self-directed education and communication to departments.

11.Performs other duties as assigned.

EDUCATION/EXPERIENCE REQUIRED:

• Bachelor's Degree in healthcare, business, or related field, or ten (10) or more years of clinical or healthcare revenue cycle experience required.

• Knowledge of Medicare, Medicaid, Medicaid OPPS reimbursement, and other third-party billing rules/coverage.

• General understanding of the hospital revenue cycle.

• Excellent written, organizational, analytical, motivational, and critical thinking skills.

• EPIC experience, preferred. Hospital billing and finance background, preferred.

CERTIFICATIONS/LICENSURES REQUIRED:

• Coding Credential (CPC, COC, CCA, CCS, RHIT) or Clinical Credential (RN, NP, PA) required.

Additional Information

• Organization: Corporate Services

• Department: Revenue Integrity

• Shift: Day Job

• Union Code: Not Applicable

  Additional Details

  This posting represents the major duties, responsibilities, and authorities of this job, and is not intended to be a complete list of all tasks and functions. It should be understood, therefore, that incumbents may be asked to perform job-related duties beyond those explicitly described above.

Overview

Partnering with nearly 2 million people on their health journey, Henry Ford Health provides a full continuum of services at 250 care locations throughout southeast and south central Michigan. With 33,000 valued team members, Henry Ford is also among Michigan’s largest and most diverse employers. Our superior care and discoveries are powered by nearly 6,000 physicians, researchers and advanced practice providers. Learn more athenryford.com.

Benefits

Whether it's offering a new medical option, helping you make healthier lifestyle choices or making the employee enrollment selection experience easier, it's all about choice. Henry Ford Health has a new approach for its employee benefits program - My Choice Rewards. My Choice Rewards is a program as diverse as the people it serves. There are dozens of options for all of our employees including compensation, benefits, work/life balance and learning - options that enhance your career and add value to your personal life. As an employee you are provided access to Retirement Programs, an Employee Assistance Program (Henry Ford Enhanced), Tuition Reimbursement, Paid Time Off, Employee Health and Wellness, and a whole host of other benefits and services. Employee's classified as contingent status are not eligible for benefits.

Equal Employment Opportunity/Affirmative Action Employer

Equal Employment Opportunity / Affirmative Action Employer Henry Ford Health is committed to the hiring, advancement and fair treatment of all individuals without regard to race, color, creed, religion, age, sex, national origin, disability, veteran status, size, height, weight, marital status, family status, gender identity, sexual orientation, and genetic information, or any other protected status in accordance with applicable federal and state laws.