Revenue Integrity Specialist

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Responsibilities

As the Revenue Integrity Specialist, you will be responsible for:

* Analyzing work flows and understanding policies related to access, billing and claims supported by the EPIC EHR system

* Maintaining expertise in multiple data sources to extrapolate information and analytics that can be presented in an easy to understand manner

* Analyzing hospital billing claims within the EHR and claim scrubber system and resolves claim errors, edits, and other holds through medical documentation review and reference to compliance guidelines from Medicare and Medi-Cal

* Evaluating and performing claims auditing for identifying and analyzing root causes for line item denials for all Government and Commercial payor sources

* Working with clinical and ancillary departments to educate managers on correct coding, billing, and charging principles

* Assisting operational managers with improving revenue capture while reversing negative outcomes, e.g. denials and/or claims rejections

* Analyzing large volumes of hospital claims data and reports generated from CareConnect, Clarity, OHIA, and Decision Support to determine potential and on-going revenue recovery initiatives and revenue recovery goals

* Leading, supporting, and coordinating charge capture activities and operations

* Assisting in charge automation initiatives, lead revenue optimization initiatives and collaborates with Revenue Cycle business partners on system enhancements and upgrades

* Supporting charge reconciliation activities and associated reporting

* Supporting hospital-based clinic departments by providing charge audit activities, education, training, charge master management support and ongoing monitoring of charge capture related metrics
Qualifications

We are seeking a detailed-oriented, self-directed professional with:

* Bachelor's Degree in Business, Accounting, Finance or related Healthcare field

* Skill in converting master files into reports for departmental use and in ad hoc technical report writing, complex analysis and data conversion into different formats

* Knowledge of the practices and procedures of the healthcare Revenue Cycle, Healthcare Finance, specifically Revenue Integrity Operations; which include charge capture, billing, coding, charge master, reimbursement, regulatory and compliance guidelines

* Experience in managing and/or developing charge capture processes, policies and procedures.

* Experience in any of the following areas is highly desirable: Finance, Consulting, Revenue Integrity Operations, Healthcare Consulting, Clinical Charge Capture, Charge Master or Revenue Cycle Operations.

* Proficiency in common database, spreadsheet and presentation software (Microsoft Excel, SQL, and PowerPoint)

* Working knowledge of reporting instruments, metrics and/or dashboard design, specifically Tableau reporting dashboard preferred

* Experience working with EPIC EHR, Cirius Claim Scrubber, or other EHR system

* Knowledge of the practices, procedures, and concepts of the healthcare revenue cycle (i.e. billing, collections, charge capture, contractual adjustments, third-party reimbursements, and cash management)

* Demonstrated communications skills, with the ability to interpret and convey complex clinical finance information in a clear, concise manner. Ability to summarize and present reports and presentation

* Demonstrated analytical and problem-solving skills, with the ability to evaluate the effectiveness of workflows and systems

* Demonstrated interpersonal skills to work effectively in a team environment with internal staff in a wide variety of business and clinical areas

UCLA is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected Veteran status.

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