Revenue Integrity Specialist (Days, Hybrid Remote, M-F weekends as needed)

Job Description

Be a part of a world-class academic healthcare system at UChicago Medicine as a Revenue Integrity Specialist for the Revenue Integritydepartment at our Hyde Park, IL location. This will be a hybrid/flexible remote opportunity where you will come in office on an as needed basis. The office location would mostly be our Hyde Park, IL location but could also be at our Burr Ridge, IL location. There are not specific set days in office but Wednesday are preferred. The start time is flexible so working hours could be from 7a - 6p, Monday - Friday and some weekends maybe required.

Job Summary:

Improve compliant and accurate billing and charge capture at the point of service in the UChicago Medicine’s (UCM) revenue cycle to decrease costly back-end work and improve cash flow. Implement and promote consistent revenue integrity practices in regards to compliance in coding, billing, and proper documentation. Optimize reimbursement working in partnership with departments to further develop the revenue stream and documentation processes. Analyzes and assists with correction of billing and coding errors identified by internal and vendor generated pre-billing edits designed to prevent claims delays & denials and non-compliant billing practices. Mitigate external audit risks via the practice of audits and continual educational efforts. Monitor detailed revenue volumes, Claim Edits, and late charges for the hospital, and provide real time notification to unusual variances. Advises regarding proper revenue cycle processes and workflows. Assists or advises departments regarding resolution of errors that prevent timely, accurate, and compliant claims submittal. Manage regulatory content, simplifying the complex reimbursement environment through promotion and support of consistent operational efficiencies. Help departments to maximize revenue when CPT (Current Procedural Technology) codes for new technologies and services, or change in the payment rates for these and other established services occur.

Essential Job Functions:

• Claims Edit Monitoring and Resolution- Provides guidance and/or assistance in the correction and prevention of Claim Edits that prevent compliant, timely, and accurate transmittal of claims for UCMC departments. Local Medical Review Policy (LMRP) edits require the review of clinical documentation against payor specific Medical Necessity guidelines such as LCD’s (Local Coverage Determination) and NCD’s (National Coverage Determination) with the review and coding of conditions and symptoms found in the Medical Record and via Physician Query to resolve the edit. APC (Ambulatory Payment Classifications) edits require the review of NCCI (National Correct Coding Initiative), OCE (Outpatient Code Editor), and MUE (Medically Unlikely Edits) requiring addition of payment modifiers to resolve the edit. HIPAA (Health Information Portability and Accountability Act) edits require the review of patient clinical or administrative data with the addition of condition and occurrence codes to resolve the edit. During course of resolution of all edits, identifies improperbilling and coding including duplication of charges, incorrect procedure billing such as under coding, up coding, wrong CPT (Current Procedural Terminology) code, or wrong number of units.Recommends changes to CPT procedures or diagnosis codes per coding guidelines. All charges inappropriate to bill require write-off decisions. Advises departments on resolution of charge disputes initiated by patients requiring review of documentation for appropriate coding and billing and recommends resolution. Monitors bill hold patterns in high volume, high dollar, or problem prone clinics with feedback and recommendations regarding process or workflow changes. Performs other duties as assigned to ensure that accurate, timely, and compliant billing can occur.
• Audits- Conducts concurrent and retrospective audits of UCMC departments designed to focus on coding, billing, and documentation. Includes audits as directed by the Office of Medical Center Compliance Committee, and/or audits related to Office of Inspector General (OIG) Work plan items, Pre-Billing & Retrospective audits (i.e., Correct Coding, Facility E/M, Infusion Coding), Claims Resolution Audits, RAC audits, Modifier Audits, Charge Capture Audits, and other audits as needed or requested, Outpatient or Inpatient. Communicates findings back to department with re-audit and education as needed based off findings. Performs other Audit duties as assigned.
• Revenue Integrity-Reviews revenue performance of UCMC departments at the cost center and charge line item level, monitoring charge capture volume in units and dollars posted. Identifies significant declines in revenue, analyzes patterns, performs sample audits, identifies revenue risk, and notifies appropriate departments and administrators of issues. Performs close revenue monitoring following events that could impact the hospital revenue cycle including implementation of Electronic Medical Record software modules or the opening of new facilities, units, or outpatient clinics. Participates in workgroups to implement process improvements which reduce claims delays and denials. Establishes Revenue Cycle and Billing Policies. Uses software such as Revenue Guardian to help identify revenue opportunities. Complete process improvement to identify issues in the revenue cycle and improve revenue cycle processes from first time billing to denials management. Reviews charge capture processes to identify revenue opportunities or risk for the hospital. Assists in developing new business procedures in order to optimize reimbursement levels. Participates in new system or software implementation design that will have an impact on any part of the revenue cycle. Advises on adjustments to charge capture, billing, and coding workflows as a result of systems implementation (new Electronic Health Record modules) that could affect the hospitals revenue cycle. Provides Order Checker End User Support for users of the software hospital wide and acts as liaison between hospital and the vendor. Maintains tables in the Billhold Database which users access to run daily bill holds, makes changes to or creates custom reports and queries to meet user needs. Maintains the RCM Intranet page. Performs other Revenue Integrity duties as assigned.
• Regulatory Review- Identify regulatory changes that impact UCMC departments who provide the service in question in order to reduce compliance risk for improper billing, as well as maximize revenue when there are new CPT or HCPCS codes available, changes in payment rates, or other considerations. Uses Chargemaster searches for identification of impacted departments, with written communication to said departments. Includes review of Outpatient Prospective Payment System Proposed and Final rules, monthly Medicare Part A & B Medical Review Policy Updates, CMS Transmittals, Medlearn Matters, State and Third Party Payor regulations, Medicare Recovery Audit Contractors, and other such bodies and regulations that include information that impact the revenue cycle of the hospital. Assists in developing new business procedures as needed in response to regulation changes. Performs other Regulatory Review duties as assigned.
• Education & Training- Identifies need for education and develops and conducts education tailored to needs of UCM departments such as infusion coding training, training on billing for new service lines, Global Period billing. Education to managers and frontline staff regarding front end processes that affect the revenue cycle downstream such as Late Charges, ABN (Advance Beneficiary Notice) check compliance, and general revenue cycle training. Conducts standing bi-monthly educational sessions for Billers, Coordinators, RNs, and other staff which earn annual Compliance Credit regarding regulatory compliance, coding, and billing topics. Also educates physicians on medicalnecessity requirements and best documentation practices to support said services. Serves as a resource to the Faculty, Clinic Coordinators, and Department Staff on Medical Necessity matters, how to bill for new services, and other billing compliance matters. Performs other Education & Training duties as assigned. Creates, updates, and maintains educational revenue cycle materials on compliant coding and billing. Regularly communicates with front end about revenue cycle matters, formally or informally. Advisement to new units, clinics, or acquisitions on revenue cycle billing matters to maximize revenue and bill compliantly.
• Denials-Analyzes top denial trends and implements plans to reduce future denials – including automation, claims edit creation, and education. Helps create template letters for common, recurring denials. As directed, works with clinical departments as a liaison to assist in reverse denials.

Required Qualifications:

• High school diploma required. Associate or Bachelor’s degree in a health-care information or health care finance related field preferred.
• Health Information Management or Coding certification required within three months of hire: RHIA (Registered Health Information Administrator), RHIT (Registered Health Information Technician), CPC (Certified Professional Coder), CCS (Certified Coding Specialist), CCS-P (Certified Coding Specialist Physician), or CCA (Certified Coding Associate).
• Proven working knowledge of CPT (Current Procedural Terminology) and ICD (International Classification of Diseases) coding systems required, with auditing experience preferred.
• Knowledge of Federal billing regulations governing Medicare and Medicaid programs, and working knowledge of other managed care and indemnity (third party) payor requirements.
• Must possess a working knowledge of Local and National Coverage Determination policies (LCD’s and NCD’s), Ambulatory Payment Classification (APC) related edits such as the National Correct Coding Initiative (NCCI) and Outpatient Code Editor (OCE), and HIPAA (Health Information Portability & Accountability Act), regulations.
• Must be proficient in Microsoft Excel, Word, Powerpoint, and have some familiarity with Access.
• Must be highly analytical, and have excellent written and verbal communication skills,
• Must possess excellent organizational, time management and multi-tasking skills, along with demonstration of
• excellent interpersonal skills.

Position Details:

• Job Type/FTE: Full Time (1.0FTE)
• Shift: Days/ Monday-Friday (some weekends may be required) (Flexible working hours) 7a-6p
• Location: Hyde Park or Burr Ridge, IL (Hybrid remote - come in office as needed/no set days - Wednesday preferred onsite)
• Unit/Department: Revenue Integrity
• CBA Code: Non-Union

Must comply with UCMC’s COVID-19 Vaccination requirement as a condition of employment. If you have already received the vaccination, you must provide proof as part of the pre-employment process. This is in addition to your compliance with the Flu Vaccination requirement as well. Medical and religious exemptions will be considered consistent with applicable law. Lastly, a pre-employment physical, drug screening, and background check are also required for all employees prior to hire.

Why Join Us

We’ve been at the forefront of medicine since 1899. We provide superior healthcare with compassion, always mindful that each patient is a person, an individual. To accomplish this, we need employees with passion, talent and commitment… with patients and with each other. We’re in this together: working to advance medical innovation, serve the health needs of the community, and move our collective knowledge forward. If you’d like to add enriching human life to your profile, The University of Chicago Medicine is for you. Here at the forefront, we’re doing work that really matters. Join us. Bring your passion.

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Bring your career to the next level at a hospital that is thriving; from patient satisfaction to employee engagement, we are at the Forefront of Medicine. Take advantage of all we have to offer and #BringYourPassiontotheForefront.

University of Chicago Medicine is growing; discover how you can be a part of this pursuit of excellence at: www.uchospitals.edu/jobs

The University of Chicago Medical Center is an equal opportunity employer. We evaluate qualified applicants without regard to race, color, ethnicity, ancestry, sex, sexual orientation, gender identity, marital status, civil union status, parental status, religion, national origin, age, disability, veteran status and other legally protected characteristics.