Reference #: 1007861SHIFT:Day (United States of America)

　　Seeking Breakthrough Makers

　　Children's Hospital of Philadelphia (CHOP) offers countless ways to change lives. Our diverse community of more than 20,000 Breakthrough Makers will inspire you to pursue passions, develop expertise, and drive innovation.

　　At CHOP, your experience is valued; your voice is heard; and your contributions make a difference for patients and families. Join us as we build on our promise to advance pediatric care-and your career.

　　CHOP's Commitment to Diversity, Equity, and Inclusion

　　CHOP is committed to building an inclusive culture where employees feel a sense of belonging, connection, and community within their workplace. We are a team dedicated to fostering an environment that allows for all to be their authentic selves. We are focused on attracting, cultivating, and retaining diverse talent who can help us deliver on our mission to be a world leader in the advancement of healthcare for children.

　　We strongly encourage all candidates of diverse backgrounds and lived experiences to apply.

　　A Brief OverviewThe Revenue Integrity Specialist serves as the key liaison and subject matter expert for assigned service line areas regarding all aspects of charge capture, charge entry and charge reconciliation processes.

　　This position will lead, support, and coordinate on-going charge capture improvement initiatives for assigned service line areas; including charge reconciliation activities, new service implementation, and identification of revenue management opportunities.The Revenue Integrity Specialist will coordinate all Revenue Integrity activities on behalf of assigned service line areas and perform department charge capture education, charge audit activities, monitor charge capture related metrics and make recommendations for revenue guardian checksThis position also has a broad understanding of all areas of the revenue cycle; including Patient Financial Services (PFS), Health Information Management (HIM), and Reimbursement Services.

　　What you will doEnsures optimal revenue recognition for all hospital departments and hospital owned physician practicesManages on-going charge capture improvement initiativesConducts 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 meetingMonitors gross revenue performance against budget and assists in root cause analysis and mitigation of discovered findingsActs as the charge capture subject matter expert and primary contact for assigned clinical areasRegularly reviews and updates charge capture related policies and procedures for assigned clinical areasMakes suggestions, initiates discussion of any applicable process improvementsCollaborates with the Revenue Integrity CDM Specialists to support ongoing CDM updates, preference list maintenance, or charge interfaces impacting charging mechanismsFacilitates charge capture related functions for new cost center or new department creationCoordinates system related upgrades or application updates between assigned clinical areas and Information Technology DepartmentProvides timely educational intervention to assigned clinical areas in support of charge capture processesDevelops educational materials (i.e. Word, PowerPoint) for assigned clinical area to use for training purposes as neededMonitors department work queues (i.e. Charge Review) of assigned areas and provides assistance to resolve WQ issues when needed to facilitate timely WQ resolutionAssesses efficiency and accuracy of revenue cycle operations for assigned clinical areasFunctions 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 plansConducts 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.Conducts third party payer and other externally requested chart/bill auditsPre-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 EPICRIS 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.Maintains knowledge of clinical care, billing, coding compliance rules and other pertinent regulationscompletes 24 hours of continuing education each yearPrepares formal reports and makes formal presentations on revenue cycle assessment findings on a regular basisRecipients 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.Assists with other projects as necessarySupports 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 QualificationsBachelor's Degree Clinical Program RequiredMaster's Degree Preferred

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

　　Skills and AbilitiesWorking knowledge of coding rulesAbility to work effectively with all members of the health care team.Working knowledge of chart/bill audits or ability to abstract medical information.Strong analy