Senior Revenue Integrity Specialist – Clinical Rev Integrity

This is a fully remote position, open to applicants in California.

📋 Description

• Lead the daily workflow for CDM maintenance.

• Oversee the compliance of various entities with standard policies for CDM maintenance.

• Guarantee the timely and precise synchronization of data between the CDM and management systems.

• Provide guidance on the documentation of all policies and procedures related to CDM Maintenance and the charge process.

• Organize meetings to assess department charge processes for potential improvements.

• Collaborate with administration, IS, Compliance, Clinical Informatics, and Integration teams on technology projects that affect charge entry and procedures.

• Supply data from multiple sources to inform critical decisions regarding the Chargemaster and CDM Maintenance.

• Address inquiries related to Chargemaster concerns and oversee educational initiatives pertaining to the CDM Maintenance process.

⛳️ Requirements

• Associate’s Degree in Business Administration, Accounting, Finance, Healthcare Administration, Nursing, or a related field.

• Certification from an accredited Certified Coder program (CPC/CCS/COC) or Certificate of Auditing (CPMA) must be obtained within one year of hire.

• A minimum of 5 years of experience in the healthcare field is required.

• Familiarity with inpatient and outpatient billing requirements (UB-04) and CMS Medicare reimbursement methodology.

• Understanding of other government and third-party payer reimbursement methodologies is essential.

• Ability to implement a systematic and self-motivated approach to problem-solving.

• Proficient in MS Office/Windows applications.

🏝️ Benefits

• Health insurance.

• 401(k) matching.

• Paid time off.

• Opportunities for professional development.