Revenue Integrity Specialist

The Johns Hopkins Health System Corporation (JHHS) is a not-for-profit organization, academically based health system, dedicated to providing the highest quality patient health care in the treatment and prevention of human illness.

What awaits you:

• Room for growth
• Medical, Dental, and Vision Insurance.
• 403B Savings Plan w/employer contribution.
• Paid Time off & Paid holidays.
• Employee and Dependent Tuition assistance benefits.

SUMMARY

This position contributes and supports Revenue Integrity’s Mission towards creating a multidisciplinary revenue integrity team to strengthen the interface between clinical departments and charge improvement process. It is a holistic approach that guides Johns Hopkins Medicine toward achieving operational efficiency, complete regulatory compliance, and total reimbursement.

The Revenue Integrity Specialist plays an important role in a high-profile group tasked with improving revenue results by taking a global view of clinical and financial processes, functions and interdependencies from the provision of patient care to final bill generation.

ESSENTIAL FUNCTIONS

• Supports associated processes for consistent and accurate charge capture and reconciliation practices in order to optimize patient revenue throughout the organization and identify opportunities for improvement and prevention of revenue leakage.
• Provides local direction and input and is expert for build and maintenance of hospital CDM both chargeable and non-chargeable items (R&B, lab, pharmacy, supplies, surgical, radiology, cardiology, etc. and physician charge master) and works collaboratively with JHHS Revenue Integrity group.
• Promotes a collaborative relationship between reimbursement, finance, clinical and operational leadership both local and with JHHS & CPA. Communicating performance opportunities, instills accountability, supports change management, monitors quality and provides routine feedback and educational opportunities.
• Oversees charge monitoring and charge capture related activities in order to identify opportunities to correct and prevent missed or incorrect charges and improve charging practices.
• Works collaboratively with JHHS to local payer audit and appeals and collaborates with centralized services for this function.
• Supports charging and pricing activities to ensure continual compliance with regulatory standards (i.e. CMS, AHCA, etc.)

QUALIFICATIONS

Education:

Bachelor’s degree required, preferably in business or healthcare

Knowledge, Skills, and Abilities:

• Experience with a progressive focus on charge to payment relationships and patient account functions and understanding of healthcare financing and reimbursement mechanisms (DRGs, EAPGs, CCI, MUE)
• Experience with clinical documentation and coding, including strong knowledge around CPT, HCPCS, ICD10-CM/PCS, revenue codes and code assignment
• Strong quantitative, analytic and problem-solving skills,
• Advanced use of Excel (i.e. sorting, pivot tables, graphs, etc.).
• Ability to plan, develop, present data/materials to an audience, including senior leaders and executives
• Strong organizational skills to handle multiple priorities of highly detailed information
• Epic Proficiency or certifications preferred
• Strong communication skills both written and verbal
• Strong understanding of laws and regulations as they pertain to coding, billing, and pricing transparency
• Requires excellent interpersonal skills in dealing with co-workers, hospital staff, patients, and payer representatives.
• Requires proven analytical ability and organizational skills necessary to organize/assess information and provide timely recommendations based on data analysis.
• Must possess excellent verbal and written communication skills to support interaction and participation in meetings with patients, physicians, payer representatives, MHA, and representatives of other departments within our organization (Medical Records, Utilization Review, JHMCIS, registration, etc.).
• Analytical skills necessary to comprehend complicated issues, and formulate creative solutions.
• Synthesize large data sets and summarize for large and diverse audiences.
• Requires strong customer service skills and a customer-centered approach to leadership.

Required Licensure, Certification, On-going Training:

Coding certification required

Work Experience:

Three (3) to five (5) years experience in the hospital setting, healthcare industry or coding with a focus in one or more of the following areas: charge integrity, charge reconciliation, charge compliance, selected forensic charge reviews, CDM management. Epic HB experience preferred.

Salary Range: Minimum 28.90/hour - Maximum 47.71/hour. Compensation will be commensurate with equity and experience for roles of similar scope and responsibility. In cases where the range is displayed as a $0 amount, salary discussions will occur during candidate screening calls, before any subsequent compensation discussion is held between the candidate and any hiring authority.

The Hospital reserves the right to modify employee schedules as needed.

We are committed to creating a welcoming and inclusive environment, where we embrace and celebrate our differences, where all employees feel valued, contribute to our mission of serving the community, and engage in equitable healthcare delivery and workforce practices.

Johns Hopkins Health System and its affiliates are drug-free workplace employers.