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Children's Hospital Boston Revenue Integrity Specialist in Boston, Massachusetts

48834BRTitle:Revenue Integrity SpecialistDepartment:Finance–Patient Financial Services AutoReqId:48834BRStatus:Full-TimeStandard Hours per Week:40 Shift:DayJob Posting Description:At Boston Children’s Hospital, success is measured in patients treated, parents comforted and teams taught. It’s in discoveries made, processes perfected, and technology advanced. In major medical breakthroughs and small acts of kindness. And in colleagues who have your back and patients who have your heart. As a teaching hospital of Harvard Medical School, our reach is global and our impact is profound. Join our acclaimed Patient Finance Services – Revenue Integrity and discover how your talents can change lives. Yours included.

This Revenue Integrity Specialist will be responsible for:

  • Performing and analyzing Epic revenue & usage reports to ensure focus on revenue cycle integrity.

  • Monitoring and correcting errors routed to revenue integrity work queues; responsible for correcting errors and clearing work queues regularly.

  • Reviewing current charging and coding structures, as well as processes in clinical departments to ensure appropriate capture and reporting of revenue and compliance with government and third party payor requirements.

  • Providing guidance, communication and education on correct charge capture, coding and billing processes to multiple clinical departments.

  • Analyzing billing error and denial data to identify root causes. Executes on work plans to correct identified deficiencies.

  • Analyzing changes to coding and billing rules and regulations by utilizing appropriate reference materials, internet sources, seminars and publications.

  • Executing on work plans to adapt systems and processes to accommodate changes.

To qualify, you must have:

  • High School diploma or equivalent required. Bachelor’s Degree preferred.

  • One year of experience within a hospital or healthcare industry billing setting.

  • Ability to review, analyze and interpret managed care contracts, billing guidelines, and state and federal regulations, i.e. Medicare and Medicaid reimbursements, as well as third party billing rules/coverage.

  • Knowledge of federal and state regulations regarding coding and billing practices.

  • Financial analysis application skills, including database development and report generation.

  • Analytical skills to resolve complex problems requiring the use of scientific, mathematical, or technical principles and in depth, experienced based cross functional knowledge.

  • Ability to identify, analyze and resolve problems and situations quickly and effectively.

  • Ability to work with diverse internal and external constituencies.

  • Strong knowledge of overall revenue cycle operations related to healthcare.

  • Excellent written and verbal communication skills.

  • Strong organizational, analytical and critical thinking skills.

  • No certification, registration or licensure required; however, applicable clinical or professional certifications/licenses, such as CPC, COC, AHIMA-CCS, RN, RT, MT, RPH, PMP are highly desirable.

Boston Children’s Hospital offers competitive compensation and unmatched benefits, including affordable health, vision and dental insurance, generous levels of time off, 403(b) Retirement Savings plan, Pension, Tuition Reimbursement and discounted rates on T-passes (50% off). Discover your best.

Boston Children’s Hospital is an Equal Opportunity / Affirmative Action Employer. Qualified applicants will receive consideration for employment without regard to their race, color, religion, national origin, sex, sexual orientation, gender identity, protected veteran status or disability.Office/Site Location:Boston

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