Revenue Integrity Specialist

Just a few of the Benefits enjoyed by PPIL employees...

-Company subsidized premiums on Medical, Dental, and Vision Insurance

-Up to 12 weeks Paid Parental Leave for eligible employees

-Generous Paid Time Off (PTO) and paid holidays

-Mission focused work

-401k with employer matching

-100% company-paid Life Insurance

-100% company-paid Short and Long Term Disability Coverage

-Robust Employee Assistance Program

-Professional Development awards and opportunities

-Flexible Spending Accounts

-Free Medical Services at PPIL

-Pet Insurance

All staff at Planned Parenthood of Illinois are required to be fully vaccinated against COVID-19. Planned Parenthood of Illinois is an equal opportunity employer and reasonable accommodations will be provided based on religious beliefs and to those with disabilities.

Revenue Integrity Specialist

The Revenue Integrity Specialist works directly with the Revenue Cycle team and proactively performs charge capture analysis, Resolves EPIC Pre-Bill suspended charge/revenue loss billing edits and maintains the Non Systems (CDM) Revenue Cycle Charge master maintenance task daily to ensure that every service that is received based on clinical documentation is captured, billed timely and reimbursed.

Essential Functions:

Charge Master

1. Research billing and coding regulations to ensure organizational compliance

2. Communicates and submits the necessary documentation and technical data to BOI that is required to implement the necessary changes that impacted policy, financial, charge capture, billing, and coding operations.

3. Perform daily maintenance and quarterly audits of the Charge master to ensure up to date coding and encounter pricing is maintained for billing accuracy

4. Liaison with Revenue Cycle, IT and clinical departments to the charge master

5. Responsible for the submission and follow up of new service codes and deactivation of outdated service codes and pricing to ensure state, federal and payer billing compliance

6. Works with purchasing to ensure that the correct annual and quarterly 340B pricing is maintained

7. Maintains current knowledge of Charge Description Master (CDM), Charge Preference List (CPL) and Flowsheet Charging to provide Revenue Cycle support

Pre-Bill Charge Capture and Reconciliation

8. Monitors the EPIC Revenue Integrity Dashboards

9. Reviews Health Center Appointments vs. Encounters reports Daily

10. Follows up with Health Center staff to ensure all services are entered into the patient accounting system

11. Works with the Health Centers if system downtime and outages are encountered to ensure that clinical documentation and charges are entered timely for billing

12. Audits charges being captured by clinical departments for accuracy and completeness. Ensures that charges are crossing to the bill as intended for RCM Vendor submissions

13. Troubleshoot charge posting issues. Identify charging opportunities. Manage assigned EPIC work queues.

14. Responsible for Reviewing and resolving all Pre-Bill suspended charge edits daily to ensure timely system claims data info crossover to the RCM Billing Vendor for Submission to the payer

Post Visit Revenue Loss Mitigation

15. Audits Post visit Charge Coding and clinical data to ensure that the appropriate Billing service codes are consistently appended prior to submission to the billing vendor to ensure OIG, state, federal and payer compliance

16. Identifies charge capture opportunities (Missed Billing, over charging, Under Charging) or compliance issues in revenue producing departments and assist with the interdepartmental implementation of process improvements.

17. Contributes to organizational improvement initiatives as directed by department leaders, focusing on exceeding the RCM KPIs for performance metrics

18. Analyses Internal Credit Balance, Automated System and Manual Vendor Contractual Adjustment Data methodologies daily to assist with identifying and resolving patient accounting inaccuracies before the month end close.

19. Actively participates in team development, achieving dashboards and in accomplishing departmental goals and objectives.

20. Maintain up to date and current knowledge of charge capture workflows and proactively maintains and increases knowledge of professional coding and revenue integrity compliance through on going self-started professional development.

21. Demonstrate an understanding of and commitment to PPIL core values of access, activism, care, confidentiality, diversity, excellence, integrity, respect, self-determination, and stewardship; practice these values in relations with internal and external customers

22. Other duties and Special Projects as assigned

Supervisor: Director of Payer Relations and Revenue Cycle Management

Status: Full-time. Non-exempt from the overtime provisions of the wage and salary regulations.

Physical Demands:

The physical demand characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is regularly required to stand, walk, talk, read, see and hear. The employee is frequently required to use hands and fingers to type, handle, or feel and reach. The employee is regularly required to sit. The employee must occasionally lift and/or move up to 25 pounds.

Education and Qualifications:

• Associates Degree or equivalent combination of experience and education preferred.

• High School Diploma or GED (Required).

• Certification in Coding is preferred.

• Strong knowledge of Commercial, Medicaid/MCO Insurances (Required).

• At least one year of experience working within EPIC as an end user is preferred.

• Knowledge of CPT, HCPCS, and Revenue Codes (Required)

• Knowledge of revenue cycle workflow processes and professional medical billing (Required)

• Must have familiarity with government and managed care reimbursement methodologies to include OPPS, and fee schedules

• Must have the ability to research payer requirements and policies

• Knowledge of NCCI edits, LCDs/NCDs (Required)

• 3+ year's revenue cycle experience including but not limited to revenue integrity, billing, coding, denials, and patient account management (Required)

• Technology skills must include expertise in the use of spreadsheet software and electronic records systems. Project management and database management skills desired.

Professional Qualities:

This Coordinator is a proactive problem-solver with strong analytic and interpersonal skills that possesses:

Excellent follow-through and attention to detail

Ability to proactively prioritize and attend to detail

Excellent interpersonal relationship management skills

Strong communication, written and oral, and excellent organizational skills

Ability to work under pressure and meet stringent deadlines, in a fast-paced environment

Commitment to maintaining confidential information

This Specialist must demonstrate a commitment to the mission and operating goals of Planned Parenthood of Illinois.

Planned Parenthood works affirmatively to include diversity among its workforce and does not discriminate in the selection of its staff based on factors including but not limited to race, color, religion, sex, national origin, age, sexual orientation, gender identity, disability, income, marital status or any other characteristic protected under federal, state or local law. We encourage diverse candidates to apply for this position.