Full-Time
40
Accounting/Finance
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.
Westwood
Regular
Part Remote/Hybrid
$69888.00-$111831.20 Annual
Boston Children's Hospital is a 404-bed comprehensive center for pediatric health care. As one of the largest pediatric medical centers in the United States, Boston Children's offers a complete range of health care services for children from birth through 21 years of age. (Our services can begin interventions at 15 weeks gestation and in some situations we also treat adults.)
We have approximately 25,000 inpatient admissions each year and our 200+ specialized clinical programs schedule 557,000 visits annually. Last year, the hospital performed more than 26,500 surgical procedures and 214,000 radiological examinations.
Our team of physicians and nurses has been recognized by a number of independent organizations for overall excellence, and we're proud to share some notable examples with you here.
