Revenue Integrity Specialist

Join the Cleveland Clinic team where you will work alongside passionate caregivers and provide patient-first healthcare. You will work alongside dedicated caregivers, receive endless support and appreciation, and build a rewarding career with one of the most respected healthcare organizations in the world.   

The Revenue Integrity Specialist is a clinical auditing resource that has an understanding of IT clinical and non-clinical applications and its use within patient care workflows for revenue integrity. A caregiver in this role will have a solid understanding of policies/procedures and regulatory requirements related to charge capture and billing to ensure compliance. The position functions in a team environment within the Revenue Integrity department. 

A caregiver in this position works remotely out of Ohio, Florida, or Nevada, Monday-Friday with a flex scheduled start time from 7:00am to 9:00am, eight hour shifts.

A caregiver who excels in this role will:  

• Comply with established corporate and departmental policies, procedures, objectives, quality assurance methods, and safety codes. Demonstrates compliance with licensing, regulatory and accrediting agency provisions as required. 

• Consistently demonstrates appropriate and professional communication behavior toward patients, customers, and coworkers. Cooperates with Management and peers to promote an environment of teamwork and collaboration. 

• Facilitate Revenue Cycle Management by identifying and recommending charge capture revenue opportunities, system data flow issues, prospective coding and revenue integrity audits, claim error resolution strategies and overall financial health. 

• Assist departmental management by providing coding and reimbursement guidelines of new procedures to ensure corporate compliance adherence to capture appropriate revenue. 

• Demonstrate successful project management skills by completing projects within designated timeframes, utilizing good planning and project coordination methods, having strong interpersonal communications, and organizational skills. 

• Perform Revenue Cycle Management System Prospective Audits, monitoring integrity of internal systems, charge capture process and missing revenue opportunities/Recommend corrective strategy. 

• Completes reviews and processes appropriate action(s) to resolve work queues as assigned. 

• Charge captures reconciliation activities to ensure accountabilities for all services performed and compliance with billing and internal standards. 

• Identify and research issues to promote appropriate and consistent coding billing practices in collaboration with Revenue Integrity Analyst. 

• Assist in special projects in relation to coding & reimbursement to facilitate revenue for new acquisitions, departments, service lines & changes in regulation. 

• Perform projects, requests and other duties as assigned by Revenue Integrity department team members. 

• Maintain Professional growth/development & current certifications through Seminars, workshops, professional affiliations to keep abreast of latest trends and develop network of professional counterparts. 

• Maintain annual mandatory education requirements specific to position as mandated. 

Minimum qualifications for the ideal future caregiver include:  

• High School Diploma or GED required 

• Minimum two years of CPT, HCPCS, and ICD-10 CM coding and/or medical billing and reimbursement experience.   

• One of the following certifications is required: 

• Certified Professional Coder (CPC) or Certified Outpatient Coder (COC) by American Academy of Professional Coder (AAPC) 

• Registered Health Information Technologist (RHIT) or Registered Health Information Administrator (RHIA) or Certified Coding Specialist (CCS) by American Health Information Management (AHIMA). 

• Certified Professional Coder (CPC-A) may be considered with additional revenue cycle experience. 

• Healthcare experience required. 

• Understanding and applying third party and governmental payer regulations. 

• Experience providing education and trend analysis related to revenue and reimbursement. 

• Must have very strong attention to detail and be able to demonstrate strong organizational and time management skills.  Excellent oral and written communication skills. 

• Able to work successfully with a diverse group of constituents including senior and midlevel leadership, Physicians and a wide range of end users are essential.  

• Ability to adapt to the technical level of the audience is a must.  

• Ability to work under time sensitive pressures and with multiple assignments concurrently is necessary. 

Preferred qualifications for the ideal future caregiver include:  

• Associate’s degree preferred. 

• Certification in coding clinical specialty hired to support is preferred.   

• Epic EHR experience is preferred.   

Our caregivers continue to create the best outcomes for our patients across each of our facilities. Click the link and see how we’re dedicated to providing what matters most to you: https://jobs.clevelandclinic.org/benefits-2/  

Physical Requirements:

• Manual dexterity to operate office equipment.

• Ability to lift and transport up to 15 pounds.

• May require extended periods of standing, walking, or sitting.

• Good visual acuity through normal or corrected vision.

Personal Protective Equipment:

• Follows standard precautions using personal protective equipment as required.

Pay Range

Salaries [which may be] shown on independent job search websites reflect various market averages and do not represent information obtained directly from The Cleveland Clinic. Because we value each individual candidate, we invite and encourage each candidate to discuss salary/hourly specifics during the application and hiring process.