Revenue Integrity Specialist

Job Summary

This Revenue Integrity Specialist will be responsible for:

• Overseeing revenue cycle operations for the Department with the goal of maximizing revenue by implementing recommended processes and functions in compliance with internal controls.
• Reviewing charge activity work queues and releasing charges from Epic to payers in compliance with Charge Description Master (CDM) with a focus on appropriate capture and reporting of revenue.
• Analyzing, supporting, and following up on complex revenue integrity initiatives.
• Providing Foundation subject matter expertise for insurance.
• Assisting front-end staff on insurance and organizational revenue integrity and charge capture policies and procedures.
• Coordinating new Attending and Fellow billing and coding training.
• Acting as the single point of contact for billing compliance and insurance audit escalations as well as annual billing and insurance plan updates.
• Providing subject matter expertise for contracting and pricing fee schedule updates, plan enrollment, and non-covered benefits.

In order to qualify, you must have:

• High School Diploma / GED
• 5 years of experience within a hospital or healthcare billing setting
• Certified Professional Coder
• Knowledgeable in revenue cycle operations
• Familiar with insurance company processes and procedures
• Ability to work with key stakeholders to optimize revenue cycle operations
• Ability to train new staff with limited insurance knowledge on medical insurance
• System proficiency with Epic, Powerchart, QCC, 3rd party insurance company websites, and clearing houses
• Knowledgeable in Current Procedural Terminology, and ICD-10 diagnosis coding (CPC certification)
• Ability to work in a deadline-driven environment
• Ability to manage billing compliance for a department of 25 health care providers
• Ability to clearly communicate complex medical information both verbally and in writing
• Skill in working with families to understand bills and educate about medical billing while de-escalating complaints
• Knowledgeable in key performance indicators of revenue cycle such as accounts receivable and payer mix

Boston Children’s Hospital offers competitive compensation and unmatched benefits including 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.