HB Revenue Integrity Specialist - Remote - 137778

UC San Diego Health's Revenue Cycle department supports the organization's mission to deliver outstanding patient care and to create a healthier world - one life at a time. We are a diverse, patient-focused, high-performing team with a commitment to quality, collaboration, and continuous improvement that enables us to deliver the maximum standard of care to our patients. We offer challenging career opportunities in a fast-paced and innovative environment and we embrace individuals who demonstrate a deep passion for problem-solving and customer service.

The Revenue Integrity Specialist (RIS) is a Revenue Integrity team member responsible for ensuring charges have been captured correctly to facilitate timely billing and appropriate reimbursement. The RIS will effectively resolve charge errors by collaborating with Coding, Patient Financial Services, IS, and other Revenue Cycle Staff stakeholders as necessary. The RIS will focus on timely completion of edits that are holding up billing and follow established policies, timeframes, government regulations, and payer requirements. The RIS will coordinate with Charge Review Specialist (CRS) to determine appropriate solutions to trended charge and claim edit issues, assist in root-cause solutions and advise service line leaders and staff on proper usage of charge codes when necessary.

Essential Functions:

• Resolves charge edit issues identified by working through assigned WQs
• Ensures timely capture of charges via WQ and edit optimization
• Determine charge issues/trends based on common issues found in WQs and Reports
• Coordinate with other RC staff to determine root cause of issues and outline suggested recommendations for resolution
• Identify new charge edits based upon root cause analysis of charging denials
• Creates education tools and resources for staff to ensure that proper usage of charge codes is occurring across UCSD
• Maintains overall financial understanding of the Revenue Integrity department through collaboration and effective communication with physicians as well as coding, billing, clinical departments, and other charge entry staff.

• Seven (7) years of related experience, education/training, OR a Bachelor's degree in related area plus three (3) years of related experience/training. Related experience: experience within technical and professional coding/charge capture, revenue cycle, healthcare operations and/or clinical setting.

• Thorough knowledge of the audit profession, theories and systems of internal control, and professional auditing standards.

• Broad knowledge of finance, accounting, business and systems operations.

• Gathers, organizes and performs analysis for moderately complex audit assignments. Is working on mastering more advanced audit concepts and applications in the completion of assignments.

• Strong interpersonal and communication skills to present sensitive information with diplomacy and in a clear and concise manner. Presents to a wide variety of audiences, including senior management and external agencies.

• May require specialized expertise in enterprise software and relational databases.

• Applicable professional certification through AHIMA (RHIA, RHIT, CCS, CCS-P), AAPC (COC, CPC,CPMA).

• Previous Hospital Billing and Coding experience.

• EPIC user experience.

• Must be able to work various hours and locations based on business needs.

• Employment is subject to a criminal background check and pre-employment physical.