Provider Revenue Integrity Specialist (hybrid)

Provider Revenue Integrity Specialist (hybrid)

84749BR

Shared Service Center

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Status

Full-Time

Standard Hours per Week

40

Job Category

Accounting/Finance,

Regular, Temporary, Per Diem

Regular

Pay Range

$69888.00-$111831.20 Annual

Office/Site Location

Westwood

Remote Eligibility

Part Remote/Hybrid

Job Posting Description

At Boston Children's Hospital, the quality of our care - and our inclusive hospital working environment - lies in the diversity of our people. With patients from local communities and 160 countries around the world, we're committed to reflecting the spectrum of their cultures, while opening doors of opportunity for our team. Here, different talents pursue common goals. Voices are heard and ideas are shared. Join us, and discover how your unique contributions can change lives. Yours included.

Position Summary: Provider Revenue Integrity Specialist (hybrid) Key Responsibilities: Monitor departments' adherence to professional charge reconciliation, work-queue, and

professional coding quality expectations and support departments with education, process

improvement, and follow-up.

• Conduct periodic departmental reviews of professional charge reconciliation processes to ensure

adherence to policies and confirm all professional charges are captured and reported accurately

• Develop, deliver, and revise revenue integrity and coding education and training programs in

coordination with the Manager.

• Monitor, investigate, and report revenue integrity and coding quality concerns to appropriate

stakeholders and provide any necessary follow-up.

• Review changes in CPT, HCPCS, and wRVUs for accuracy, compliance with applicable coding and billing guidelines, and optimization of reimbursement.
• Support departments with analyzing services for coverage and reimbursement.
• Work with departments to identify revenue management opportunities, staying current with

government and commercial payer's billing and coding requirements.

• Develop, deliver, and revise revenue integrity and coding education and training programs in

coordination with the Manager.

• Monitor, investigate, and report revenue integrity and coding quality concerns to appropriate

stakeholders and provide any necessary follow-up.

• Monitor national, state, and local information to keep current with applicable regulatory and

legislative changes and tailor the revenue integrity program accordingly.

• Monitor coder quality audit results and coder productivity. Support departments by establishing

audit processes, education and training, process improvement, and follow-up.

• Lead assigned revenue integrity and coding projects, committees, and meetings.
• Develop and execute tools and processes to identify potential areas of delayed or lost revenue.

Collaborate with departments on process improvement and necessary follow-up.

• Build strong relationships and facilitate effective communication between key stakeholders.

Collaborate with others to develop and implement action plans to resolve revenue integrity and

coding issues.

• Prepare oral and written reports and presentations summarizing reviews, findings,

recommendations for improvement, and actions taken for the Director and other stakeholders.

• Knowledge of Healthcare Revenue Cycle: Understanding of billing, coding, collections and

regulatory requirements. Strong knowledge of medical billing, coding (ICD-10, CPT, HCPCS) and

payer policies. Working knowledge of financial principles and metrics related to effective revenue

cycle management.

• Documentation and Organization: Ability to create concise summaries and workflows for use in

operationalizing procedures and payer rules. Ability to develop and maintain a centralized,

searchable policy library, including version control and dating strategies. Ability to prioritize, and

reprioritize, tasks to meet deadlines. Ability to reprioritize tasks as needed. Ability to craft

impactful audit responses and appeals letters.

License preferred: Clinical license such as Registered Nurse (RN),

Registered Respiratory Therapist (RT), Medical Technologist (MT), Registered Pharmacist (RPh).

Certification preferred: Coding certification such as Certified Professional Coder (CPC), Certified Outpatient Coder (COC), or AHIMA Certified Coding Specialist (CCS). Project Management Professional (PMP).

Minimum Qualifications Education: High-school and/or GED required. Bachelor's Degree preferred

Experience: 5 years experience in a healthcare billing setting required. Experience in healthcare revenue cycle operations and/or physician coding preferred.

The posted pay range is Boston Children's reasonable and good-faith expectation for this pay at the time of posting.

Any base pay offer provided depends on skills, experience, education, certifications, and a variety of other job-related factors. Base pay is one part of a comprehensive benefits package that includes flexible schedules, affordable health, vision and dental insurance, child care and student loan subsidies, generous levels of time off, 403(b) Retirement Savings plan, Pension, Tuition and certain License and Certification Reimbursement, cell phone plan discounts and discounted rates on T-passes. Experience the benefits of passion and teamwork.

Boston Children's Hospital is an Equal Opportunity Employer. We do not discriminate on the basis of race, religion, color, gender, sexual orientation, pregnancy, national origin, ancestry, ethnicity, age, disability, military or veteran status or any other classification protected by law in hiring, promotion, compensation and other terms and conditions of employment. Boston Children's Hospital collects and maintains information regarding gender, race, and ethnicity for equal opportunity compliance purposes. Boston Children's Hospital also is subject to various government recordkeeping and reporting requirements for the administration of civil rights laws and regulations.

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