Revenue Integrity Specialist PB

Inova 8095 - Fairfax East is looking for a dedicated Revenue Integrity PB Specialist to join the team. This role will be full-time day shift Monday - Friday, Business Hours -

Inova is consistently ranked a national healthcare leader in safety, quality and patient experience. We are also proud to be consistently recognized as a top employer in both the D.C. metro area and the nation.

Featured Benefits:

• Committed to Team Member Health: offering medical, dental and vision coverage, and a robust team member wellness program.

• Retirement: Inova matches the first 5% of eligible contributions - starting on your first day.

• Tuition and Student Loan Assistance: offering up to $5,250 per year in education assistance and up to $10,000 for student loans.

• Mental Health Support: offering all Inova team members, their spouses/partners, and their children 25 mental health coaching or therapy sessions, per person, per year, at no cost.

• Work/Life Balance: offering paid time off and paid parental leave.

Revenue Integrity PB Specialist Job Responsibilities:

The Revenue Integrity Physician Billing Specialist is responsible for working with revenue-producing clinical departments/service lines across the Inova enterprise to ensure efficient, accurate, and compliant charge capture and charge reconciliation processes. Aligns with department/service line leadership and serves as the subject matter expert regarding the accuracy of charge capture processes including education, audit activities, changes or risk to revenue (regulatory or coding changes), and monitoring of charge capture-related metrics to minimize revenue leakage.

• Works with service line leaders to ensure regulatory compliance for new and existing services, implements charge capture process improvements and annual updates to CPT/HCPCS code selections.

• Collaborates with service lines, HIM, and other key stakeholders to improve charge capture, compliant documentation to substantiate charges, charge reconciliation, and compliant billing of all charges.

• Scope of work includes claim edits (CCI/LCD), follow-up denials, customer service/patient complaints, write-off requests, specialty projects, and training in charge entry. Ensures accurate and complete assignment of CPT/HCPCS codes, modifiers, and diagnoses that are supported by medical record documentation.

• Analyzes charge review findings and recommends to Revenue Cycle administration leadership in order to improve documentation, charging flow and accuracy.

• Reviews denial trends for documentation and charging opportunities and provides feedback on educational gaps.

• Performs appropriate analytics as daily work queue management functions are performed; performs verification of billing data for accuracy and completeness; and performs charge reviews by verifying billing data as compared to documentation and making corrections in patient accounting as needed.

• Partners with the Billing team counterparts to determine how claim errors related to coding or charge review are resolved for purposes of accurate billing of claims for payment.

• Reviews, monitors and resolves claims. Evaluates if account combinations and account splits are appropriately applied. Performs medical necessity validation required to ensure timely and accurate processing of claims.

• Reviews Inova Health System registration communications, applicable Centers for Medicaid & Medicare Services transmittals, National Coverage Decisions and Local Coverage Decisions.

• Reviews denial trends for documentation/charging opportunities and provides feedback on educational gaps.

• Provides support to manager to review and interpret revenue cycle reports to drive accountability and transparency in performance. Provides ongoing support to manager to improve service line charge capture and charge reconciliation workflows.

• Reviews analytics to validate accurate charge capture and reporting of charges; identify issues, perform root/cause analysis, and proposes solutions to manager. Reviews denials transferred from PFS team, analyzes root cause, corrects, or provides appeal support for claims as necessary and documents denials in tracker for trending analysis. Reviews Claim Edit WQs and proactively resolves and proposes solutions to prevent charging edits

• Works closely with Health Information Management (HIM), Clinical Documentation Improvement (CDI), Clinical Informatics, and Patient Financial Services (PFS) departments to resolve charge capture related issues.

• Maintains knowledge of any CDM requests for the assigned department(s)/service lines(s) and support effective implementation and education and maintains knowledge of Electronic Health Record (EHR) reports and resources available to RI team by working collaboratively with EHR IT.

• Participates actively in team development, achieving KPIs, and accomplishing department goals.

• May perform additional duties as assigned.

Minimum Qualifications:

• Certification - Certified coding specialist or AAPC/AHIMA: RHIT, RHIA CCS, CPC, CPC-H
• Experience - Five years of experience in either a coding or billing role
• Education - Associate's Degree in a healthcare or finance related field