Revenue Integrity Specialist

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A Brief Overview

The Revenue Integrity Analyst plays a pivotal role in ensuring accurate charge capture, billing and reimbursement across our revenue cycle. You’ll collaborate closely with the Revenue Integrity Specialist (RIS), Revenue Integrity Auditors, and the CDM team — and serve as the key liaison between the RIS and their assigned clinical departments. In this visible, impactful role you’ll help improve internal processes and policies turning them into practical, compliant workflows that optimize reimbursement and reduce denial risk. Ideal candidates are skilled at building productive relationships across departments. If you enjoy problem-solving, cross-functional collaboration, and making a measurable difference in revenue operations, this is an exciting opportunity to grow your career in a mission-driven organization.

Work Environment & Flexibility

Mostly Remote (Monday-Friday; 8am-5pm) for optimal work-life balance
Onsite requirements:  Quarterly onsite meetings with team required at CHOP- to inspire teamwork by bringing the group together to plan boldly, connect meaningfully, and innovate for lasting impact.

Ready to grow with us? Apply today and help shape the future of Revenue Cycle at CHOP.

Apply today and help strengthen the financial health of our hospital system—while enjoying the flexibility of a fully remote role.

What you will do

1) Ensures optimal revenue recognition for all hospital departments and hospital owned physician practices

• Manages on-going charge capture improvement initiatives
• Conducts quarterly on-site meetings with assigned service line clinical departments to ensure accurate charge capture practices and workflows are in place; review a) RI charge capture-charge reconciliation policy, b) departments' charge entry-charge reconciliation policy and c)the RI Check-in checklist at each meeting
• Monitors gross revenue performance against budget and assists in root cause analysis and mitigation of discovered findings
• Acts as the charge capture subject matter expert and primary contact for assigned clinical areas
• Regularly reviews and updates charge capture related policies and procedures for assigned clinical areas
• Makes suggestions, initiates discussion of any applicable process improvements
• Collaborates with the Revenue Integrity CDM Specialists to support ongoing CDM updates, preference list maintenance, or charge interfaces impacting charging mechanisms
• Facilitates charge capture related functions for new cost center or new department creation
• Coordinates system related upgrades or application updates between assigned clinical areas and Information Technology Department
• Provides timely educational intervention to assigned clinical areas in support of charge capture processes
• Develops educational materials (i.e. Word, PowerPoint) for assigned clinical area to use for training purposes as needed
• Monitors department work queues (i.e. Charge Review) of assigned areas and provides assistance to resolve WQ issues when needed to facilitate timely WQ resolution

2) Assesses efficiency and accuracy of revenue cycle operations for assigned clinical areas

• Functions as the Project Manager for revenue cycle process assessments 2x/year (planned)
• The assessment includes the areas of registration, charge capture, coding, documentation, billing, reconciliation, payer reimbursement, and compliance.
• Uses established project management tools, methodology to conduct revenue cycle assessments.
• Identifies project leadership team and members, defines project scope, and develops assessment plans
• Conducts assessment activities such as interviews, outcomes analysis, process flows and analysis, documentation reviews, and direct clinical observations as needed.
• Identifies quick hits and redesign opportunities for each project.
• Communicates regularly with key stakeholders about the progress, critical factors and obstacles related to each revenue cycle assessment.
• Assists in developing metrics to be used for ongoing monitoring.
• Prepares and presents high quality reports of the revenue cycle department assessment and the findings to various audiences.
• Implements quick hit items within the designated time period; Functions as a content expert resource for the redesign activities.
• Monitors revenue activity after the process improvement strategies have been implemented.
• Works toward meeting institutional goal of increasing revenue through improved charge capture processes.
• Performs all required activities to ensure proper and accurate reimbursement.

3) Conducts third party payer and other externally requested chart/bill audits

• Pre-audit will be conducted prior to scheduled audit date 100% of the time.
• Schedules audits within 10 days of the audit request 95% of the time.
• Completes post audit paperwork and sends these documents to PFS within 3 business days of finalized audit, noting the audit has been completed in EPIC
• RIS will give a copy of all the completed audit paperwork to the RI Charge Analyst within 5 business days of the audit being completed.
• Communicates significant audit findings to appropriate Department Manager and Senior Finance Partner within 2 weeks of audit completion so corrective actions will be taken as needed.
• 4) Maintains knowledge of clinical care, billing, coding compliance rules and other pertinent regulations
• completes 24 hours of continuing education each year

5.) Prepares formal reports and makes formal presentations on revenue cycle assessment findings on a regular basis

• Recipients may include clinical staff and department managers, members of Administration, PARC staff, etc.
• Demonstrates excellent verbal communication skills.
• Demonstrates excellent written communication skills.
• Demonstrates expert use of applications such as Word, Excel, and PowerPoint in written reports.

6.) Assists with other projects as necessary

• Supports Revenue Analytics Team with month end close.
• Contributes to Revenue Analytics providing clinical care and billing guidance for contract negotiations.
• Collaborates with Internal Audit and Billing Compliance Departments on clinical department reviews and remediation of any issues.
• Collaborates with PFS to help resolve Billing and/or Collection issues

Education Qualifications

• Bachelor's Degree Clinical Program Required
• Master's Degree Preferred

Experience Qualifications

• At least five (5) years Clinical experience as a RN, NP/APN, RT or other related clinical specialist area Required
• Experience using billing and documentation systems Preferred
• Previous professional work in a clinical area Required

Skills and Abilities

• Working knowledge of coding rules
• Ability to work effectively with all members of the health care team.
• Working knowledge of chart/bill audits or ability to abstract medical information.
• Strong analytical and organizational skills.
• Excellent verbal and written communication skills.
• Must be able to work independently.
• Strong project management skills.
• Effective leadership skills
• Will be required to manage multiple complex projects simultaneously
• Must be detail, action, solution, and results oriented
• Working knowledge of revenue cycle processes
• Computer skills essential
• Will need to use Word, Excel, PowerPoint, and Visio at a minimum

Licenses and Certifications

• Registered Nurse (Pennsylvania) - Pennsylvania State Licensing Board - upon hire - Required or
• Respiratory Therapist (Pennsylvania) - Pennsylvania State Licensing Board - upon hire - Required
• Certified Professional Coder (CPC) - American Academy of Professional Coders (AAPC) - - Preferred

To carry out its mission, CHOP is committed to supporting the health of our patients, families, workforce, and global community. As a condition of employment, CHOP employees who work in patient care buildings or who have patient facing responsibilities must receive an annual influenza vaccine. Learn more.
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SALARY RANGE:

Salary ranges are shown for full-time jobs. If you're working part-time, your pay will be adjusted accordingly.

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At CHOP, we are committed to fair and transparent pay practices. Factors such as skills and experience could result in an offer above the salary range noted in this job posting. Click here for more information regarding CHOP's Compensation and Benefits.