About City of Hope
City of Hope is an independent biomedical research and treatment organization for cancer, diabetes and other life-threatening diseases.
Founded in 1913, City of Hope is a leader in bone marrow transplantation and immunotherapy such as CAR T cell therapy. City of Hope’s translational research and personalized treatment protocols advance care throughout the world. Human synthetic insulin, monoclonal antibodies and numerous breakthrough cancer drugs are based on technology developed at the institution. AccessHope™, a subsidiary launched in 2019 serves employers and their health care partners by providing access to City of Hope’s specialized cancer expertise.
A National Cancer Institute-designated comprehensive cancer center and a founding member of the National Comprehensive Cancer Network, City of Hope is ranked among the nation’s “Best Hospitals” in cancer by U.S. News & World Report and received Magnet Recognition from the American Nurses Credentialing Center. Its main campus is located near Los Angeles, with additional locations throughout Southern California and in Arizona.

City of Hope’s commitment to Diversity, Equity and Inclusion
We believe diversity, equity and inclusion is key in serving our mission to provide compassionate patient care, drive innovative discovery, and advance vital education focused on eliminating cancer and diabetes in all of our communities. Our commitment to Diversity, Equity and Inclusion ensures we bring the full range of skills, perspectives, cultural backgrounds and experiences to our work -- and that our teams align with the people we serve in order to build trust and understanding. We are dedicated to fostering a community that embraces diversity - in ideas, backgrounds and perspectives; this is reflected in our work and represented in our people.

Position Summary
The Senior Revenue Integrity Specialist (SRIS) serves as a charge capture/charge description master expert to clinical service line leaders and processes are in compliance with Federal/State guidelines. This position identifies revenue opportunities and works collaboratively with Revenue Cycle and Clinical staff to develop a work plan to ensure process improvement is understood by departmental managers and staff and is documented throughout the revenue cycle with the expected outcome being increased revenue capture and decreased denials.
Another objective of the SRIS is responsible for training needs and quality monitoring to ensure revenue capture in compliance with regulations, accreditation agencies, organizational policies and standard operating procedures. Provide objective expertise to improve the value and effectiveness of revenue cycle services, including operational workflow and system enhancements. The SRIS will work with RI manager to execute a training strategy and plan; create assessment tools and competencies, training materials, including job aids and tool kits. The SRIS will be responsible for scheduling and performing training needs assessments and training sessions; including orientation and ongoing activities, measuring and reporting outcomes. The position is responsible for performing various audits for each functional area to ensure data integrity and compliance of process guidelines and effectiveness of the training. Will also perform revenue monitoring and clinical data quality review audits and assessments as requested.

Key Responsibilities include:
Charge Capture/CDM Tasks

• Analyzes charge transactions along with Research documentation to properly bill Research sponsors for protocol related services provided to the patient
• Verifies medical procedure documentation and completeness of the Medical Record. Requests documentation as needed to support charges.
• Coordinates/conducts entrance and exit audit interviews with third party payers in relation to patient bills. Recommends to management the appropriate actions and strategies to be taken.
• Reviews medical records for appropriate documentation to appeal proposed clinical and technical denials
• Conducts special patient charge studies for various departments. Develops data and provides interpretation of intangible or unusual factors and summarizes findings appropriately.
• Maintains a record of audit account activity and takes appropriate follow-up actions.
• Interprets and explains to patients or family members the details of medical services provided, if requested.
• Serves as charge capture/charge description master expert to clinical service line leaders for all areas.
• Monitoring on specific clinical service lines to ensure best practices. Champions standardization of charge capture process, and ensures appropriate discipline-specific charge capture as it relates to government and commercial payer requirements.
• Performs charge reconciliation activities, industry best practice research, and identifies and deploys charge capture improvement initiatives.
• Ensures charge capture revenue management opportunities are identified and service line specific reimbursement and revenue management is reviewed and monitored.
• Coordinates with CDM Analyst, Billers, and Auditors to identify revenue management opportunities, conducts charge reconciliation to ensure optimal charge capture, and reviews and monitors service line specific information regarding hospital services, reimbursement, and revenue management
• Conducts routine on-site meetings with clinical staff and all hospital departments to ensure all charges are being captured and reported accurately using the correct charging methodology
• Identifies system-wide best practices by specialty and works with all affiliates to establish best practices in that specialty throughout City of Hope
• Collaborates with the Denial Management team, Auditors and Billing ream in order to contribute to resolving claims issues
• Stays current with government and commercial payer billing and charging regulations/requirements and industry charge capture best practices
• Participates in charging and billing decisions/interpretations at the department and system-wide level and ensures proper documentation for all services rendered by the department
• Assist with review and perform manual charge entry/correction as needed.

Education/Training

• Participates collaboratively with Revenue Cycle and Ancillary team in the development, execution and follow-up of education programs for City of Hope Administration, Managers and Staff on all issues related to the charge master, charge capture, and new applications related processes.
• Collaborates with Denial Management team, Finance, Audit, Compliance, and other departments to prepare and deliver educational materials regarding accurate charging, billing and documentation for customers
• Participates in special projects as assigned
• Enhances professional growth and development
• Review charge capturing workflows to ensure efficiency and effectiveness. This includes:
• Improvement of department processes and procedures to assure timely and accurate capture of all chargeable activities;
• Development of action plan with responsible parties and due dates of issues identified;
• Development of policies and procedures, monitoring tools for late charges and establishment of procedures for timely and accurate charge capture mechanisms;
• Development and maintenance of collaborative working relationship with revenue producing departments, information systems personnel, technical and clinical personnel on reconciliation to identify chargeable activities, to establish charge capture mechanisms, and orderly and timely recording of revenue.
• Quarterly audit of the appropriateness of the accuracy of departmental charge capture modules/workflows. Prepares report of findings for management
• Actively participates in team development, contributes to dashboards, and in accomplishing team, departmental, and organizational goals and objectives.
• Performs other related duties as assigned or requested.
  

Basic education, experience and skills required for consideration:

• Bachelor's Degree; 4 additional years of experience plus the minimum experience requirement may substitute for minimum education.
• Minimum of five (5) years of experience working in Revenue Integrity, Charge Capture, Coding, or Compliance preferably in a hospital and/or in a professional/ambulatory healthcare environment.
• At least five (5) years’ experience performing auditing RAC/ADR, billing, or CDM

Required Certification/Licensure:

• Active certification as a Certified Coding Specialist (CCS) or Certified Coding Specialist-Physician Based (CCS-P) from the American Health Information Management Association (AHIMA)

Preferred education experience and skills:

• Master’s Degree

Additional Information:

• As a condition of employment, City of Hope requires staff to comply with all state and federal vaccination mandates.
• City of Hope is committed to creating a diverse environment and is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sex, sexual orientation, gender identity, age, status as a protected veteran, or status as a qualified individual with disability.

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