Revenue Integrity Specialist
Sheridan Memorial Hospital, Sheridan, WY, United States
Job Summary
The Revenue Integrity Specialist provides assistance and analysis to all levels of clinical management at Sheridan Memorial Hospital (SMH) in support of suggested, requested and mandated changes to the Charge Description Master CDM. Along with Patient Accounting Staff, maintains the SMH facility and clinic chargemaster within applicable coding guidelines and SMH Policies and Procedures, assists with bill problem resolution, and researches and communicates coverage guidelines for billable services. Works with clinical directors and managers to implement and monitor CDM changes. Monitors daily charging activity to ensure accurate charging and provides feedback on charge capture opportunities. Works directly with the CFO in developing and maintaining a charge philosophy for the organization and with department heads to ensure workflows adhere to this philosophy. Provides support to the Revenue Cycle and/or HIM leadership as needed and follows the annual quarterly charge master review, cost‑up, code changes, price changes, and service line updates. Collaborates across multiple areas for teamwork.
Benefits Include
Medical, Dental, and Vision Insurance
Low deductibles and out‑of‑pocket costs
Coverage begins the month after you start
Tuition Assistance available after one year of employment
Retirement Match: 6% match with full vesting after 3 years
Generous PTO and Sick Time
Employer‑Paid Life Insurance
Short‑Term Disability Coverage
Employee Assistance Program (EAP)
Benefits and eligibility vary by position; exclusions may apply.
Essential Job Functions
Monitors and maintains hospital and clinic departmental charge master to ensure coding and billing accuracy of new and existing service codes.
Work with clinical directors and managers to implement and monitor CDM changes.
Evaluates department requests to ensure that all additions, changes and deletions are consistent with proper charging and coding practices.
Performs claim coding edits daily related to the CDM.
Works with clinical directors and managers to ensure appropriate bundling or unbundling of charges so that all charges are submitted to result in appropriate reimbursement while following applicable billing reimbursement regulations; assists Patient Accounting personnel in resolving third‑party payer billing problems.
Works with Medicare intermediaries and CMS to clarify billing requirements, documents and tracks all communications from government agencies.
Ensures SMH meets regulatory requirements for price transparency.
Reviews Medicare newsletters, updates, and performs periodic reviews of CMS Medicare fiscal intermediary websites and remains informed of pending changes; communicates pertinent information to applicable departments.
Works with advisory vendors on CDM audits.
Develops, implements, and monitors the charge‑master database system, enabling reporting on financial and operational CDM data.
Works with the Director of Finance on forecasting of revenues based on CDM changes.
Aims for a 3‑year plan for a CDM accuracy rate ≥ 99.5%.
Aims for a 3‑year plan to increase the % of total facility and clinic charges processed end‑to‑end through automated workflows to > 80%.
Targets a 15% reduction of charge exceptions within the first year, working towards 5% by year 3.
Builds and maintains charge transformation rules.
Completes quarterly charge‑master reviews within 2 weeks of the start of each quarter.
Works with various data sources in monitoring and evaluation of the charge master; comfortable with large data sets.
Chairs the monthly revenue integrity committee meeting and reports directly to the CFO on work lists and progress.
Plays a pivotal role in developing and maintaining charge automation organization‑wide.
Position Qualifications Education, Experience & License
High school diploma or GED, required.
Bachelor's degree in a health‑care‑related field, business, finance or accounting, or an associate’s degree in Health Care, preferred.
Professional License (e.g., nursing, radiology, respiratory therapy).
Three years’ experience in a chargemaster or revenue integrity related role, or three years of related experience with knowledge of CPT/HCPCS coding and revenue coding, required.
Preferred: advanced working knowledge of Microsoft Office programs and other software for researching issues concerning CDM maintenance.
Preferred coding certifications: CPC, CPC‑H (AAPC) or CCS (AHIMA), RHIT, RHIA, or relevant experience and CEU.
Additional Skills
Ability to communicate in English, both verbally and in writing.
Additional languages preferred.
Thorough understanding of Medicare, Medicaid, HMO, PPO, and private insurance companies.
Specific demands not listed: Possible exposure to blood and/or body fluids/infectious disease/hazardous waste requiring the use of personal protective equipment. Exposure to odorous chemicals, specimens, and latex products.
Pre‑employment drug and alcohol screening is required.
Legal & EEO Statement Sheridan Memorial Hospital is an equal opportunity/Affirmative Action employer and gives consideration for employment to qualified applicants without regard to race, color, religion, age, sex, national origin, disability or protected veteran status. If you would like more information about your EEO rights as an applicant under the law, please note that Sheridan Memorial Hospital does not provide a link for clicking here.
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Benefits Include
Medical, Dental, and Vision Insurance
Low deductibles and out‑of‑pocket costs
Coverage begins the month after you start
Tuition Assistance available after one year of employment
Retirement Match: 6% match with full vesting after 3 years
Generous PTO and Sick Time
Employer‑Paid Life Insurance
Short‑Term Disability Coverage
Employee Assistance Program (EAP)
Benefits and eligibility vary by position; exclusions may apply.
Essential Job Functions
Monitors and maintains hospital and clinic departmental charge master to ensure coding and billing accuracy of new and existing service codes.
Work with clinical directors and managers to implement and monitor CDM changes.
Evaluates department requests to ensure that all additions, changes and deletions are consistent with proper charging and coding practices.
Performs claim coding edits daily related to the CDM.
Works with clinical directors and managers to ensure appropriate bundling or unbundling of charges so that all charges are submitted to result in appropriate reimbursement while following applicable billing reimbursement regulations; assists Patient Accounting personnel in resolving third‑party payer billing problems.
Works with Medicare intermediaries and CMS to clarify billing requirements, documents and tracks all communications from government agencies.
Ensures SMH meets regulatory requirements for price transparency.
Reviews Medicare newsletters, updates, and performs periodic reviews of CMS Medicare fiscal intermediary websites and remains informed of pending changes; communicates pertinent information to applicable departments.
Works with advisory vendors on CDM audits.
Develops, implements, and monitors the charge‑master database system, enabling reporting on financial and operational CDM data.
Works with the Director of Finance on forecasting of revenues based on CDM changes.
Aims for a 3‑year plan for a CDM accuracy rate ≥ 99.5%.
Aims for a 3‑year plan to increase the % of total facility and clinic charges processed end‑to‑end through automated workflows to > 80%.
Targets a 15% reduction of charge exceptions within the first year, working towards 5% by year 3.
Builds and maintains charge transformation rules.
Completes quarterly charge‑master reviews within 2 weeks of the start of each quarter.
Works with various data sources in monitoring and evaluation of the charge master; comfortable with large data sets.
Chairs the monthly revenue integrity committee meeting and reports directly to the CFO on work lists and progress.
Plays a pivotal role in developing and maintaining charge automation organization‑wide.
Position Qualifications Education, Experience & License
High school diploma or GED, required.
Bachelor's degree in a health‑care‑related field, business, finance or accounting, or an associate’s degree in Health Care, preferred.
Professional License (e.g., nursing, radiology, respiratory therapy).
Three years’ experience in a chargemaster or revenue integrity related role, or three years of related experience with knowledge of CPT/HCPCS coding and revenue coding, required.
Preferred: advanced working knowledge of Microsoft Office programs and other software for researching issues concerning CDM maintenance.
Preferred coding certifications: CPC, CPC‑H (AAPC) or CCS (AHIMA), RHIT, RHIA, or relevant experience and CEU.
Additional Skills
Ability to communicate in English, both verbally and in writing.
Additional languages preferred.
Thorough understanding of Medicare, Medicaid, HMO, PPO, and private insurance companies.
Specific demands not listed: Possible exposure to blood and/or body fluids/infectious disease/hazardous waste requiring the use of personal protective equipment. Exposure to odorous chemicals, specimens, and latex products.
Pre‑employment drug and alcohol screening is required.
Legal & EEO Statement Sheridan Memorial Hospital is an equal opportunity/Affirmative Action employer and gives consideration for employment to qualified applicants without regard to race, color, religion, age, sex, national origin, disability or protected veteran status. If you would like more information about your EEO rights as an applicant under the law, please note that Sheridan Memorial Hospital does not provide a link for clicking here.
#J-18808-Ljbffr