What are the responsibilities and job description for the Revenue Integrity Specialist (Pathology) position at Henry Ford Health - Careers?
GENERAL SUMMARY:
The Revenue Integrity Specialist 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 revenue capture accuracy, decreased denials utilizing standard optimized workflow, and reducing organization risk by upholding compliance standards.
Under limited supervision, the Revenue Integrity (RI) Specialist is responsible for multiple Revenue Integrity initiatives involving multiple clinical departments and practices focusing on revenue cycle integrity. The RI Specialist understands hospital payor contracts and reimbursement methodologies. Works collaboratively with Revenue Integrity staff to identify charge system weakness, recommends changes, provide education, and tracks utilization.
Due to its service focus and project management emphasis, this position requires strong interpersonal and communication skills, well-developed analytic and organizational skills.
The Revenue Integrity Specialist utilizes a variety of process improvement initiatives while working with individuals and teams. Works collaboratively with Revenue Integrity team members and leadership to increase efficiencies, reduce variability, reduce errors/defects, provide training and education involving all appropriate personnel. Prepares reports and recommendations for management and coordinates implementation.
The Revenue Integrity Specialist identifies possible Revenue Guardian rules based on findings, to target identification of possible missed charge scenarios. Rules should be specific and precise to identify missed revenue with high degree of accuracy.
May supervise work and function as a resource for RI Auditors and RI Senior Auditors.
Flexibility, innovation, and creativity are necessary characteristics of the successful candidate. Individual is expected to continuously learn and apply new continuous improvement methodologies, and to spread successful innovation through the institution.
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 charges accurately, and summarize findings for department leadership, providers, and ancillary staff.
3. Identifies charge trends and provides education, creates Revenue Guardian checks, and make recommendations to workflow for process improvement.
4. Coordinates with the RI Senior Auditor and 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.
5. Coordinates with RI Senior Auditor and RI Auditor to review accounts comparing the medical record and itemized bill to identify charging and billing weaknesses in the system.
EDUCATION/EXPERIENCE REQUIRED:
• Bachelor’s degree in Business Administration, Healthcare Administration, Nursing or related area, or five (5) years of leadership and/or consultative experience in lieu of Bachelor’s degree, required.
• Two (2) years experience in healthcare revenue cycle, finance, clinical areas or related experience, required.
• Hospital billing and finance background, preferred.
• Ability to work with and interpret detailed medical record documents and communicate effectively with physician, nursing staff, leadership and other HFH personnel.
• Knowledge of medical coding (facility and professional), related medical terminology, use of medical records, billing claim forms, and federal and state regulations related to rules/coverage.
CERTIFICATIONS/LICENSURES REQUIRED:
- Coding Credential (CPC, COC, CCA, CCS, RHIT) or Clinical Credential (RN, NP, PA) preferred.