Revenue Integrity Specialist at Sheridan Memorial Hospital – Sheridan, Wyoming

ABOUT SHERIDAN MEMORIAL HOSPITAL

At Sheridan Memorial Hospital, we proudly rank in the top 13.6% of U.S. hospitals, recognized by the Centers for Medicare and Medicaid Services. With over 850 dedicated employees and 100+ expert providers across 25 specialties, we are committed to exceptional, patient-centered care. Set in northern Wyoming’s stunning Big Horn Mountain foothills, Sheridan offers outdoor adventure and community charm. Our hospital combines cutting-edge technology with a collaborative, innovative culture. Join a team that values your skills, fosters growth, and empowers you to impact lives meaningfully. Apply today and be part of Sheridan Memorial Hospital’s mission of excellence!
JOB SUMMARY

The Revenue Integrity Specialist provides assistance and analysis to all levels of clinical management at Sheridan Memorial Hospital (SMH) in support of suggested, requested and or mandated changes to the Charge Description Master CDM. Along with Patient Accounting Staff, maintains the SMH facility and Clinic chargemaster within applicable coding guidelines and SMH Policies and Procedures, assists with bill problem resolution, and researches and communicates coverage guidelines for billable services. Works with clinical directors and managers to implement and monitor CDM changes. Monitors daily charging activity to ensure accurate charge and will work directly with department heads on charge capture opportunities and provide feedback on updates. Works directly with the CFO in developing and maintaining a charge philosophy for the organization. Will work directly with department heads to ensure workflows adhere to this philosophy. Provides other support to the Revenue Cycle and/or HIM leadership as needed. Follows the annual quarterly charge master review, true up, code changes, price changes and service line updates. Teamwork and collaboration with multiple areas.

Benefits Include:

• Medical, Dental, and Vision Insurance


• Low deductibles and out-of-pocket costs


• Coverage begins the month after you start.


• Tuition Assistance


• Available after one year of employment


• Retirement Match


• 6% match with full vesting after 3 years


• Generous PTO and Sick Time


• Employer-Paid Life Insurance


• Short-Term Disability Coverage


• Employee Assistance Program (EAP)

Benefits and eligibility vary by position; exclusions may apply.
ESSENTIAL JOB FUNCTIONS

• Monitors and maintains hospital and clinic departmental charge master to ensure coding and billing accuracy of new and existing service codes.


• Work with clinical directors and managers to implement and monitor CDM changes.


• Evaluates department requests to ensure that all additions, changes and deletions are consistent with proper charging and coding practices.


• Works claim coding edits daily as it relates to the CDM


• Work with clinical directors and managers to ensure the appropriate bundling or unbundling of charges so that all charges are submitted to result in appropriate reimbursement while following applicable billing reimbursement regulations. Assist Patient Accounting personnel in resolving third-party payer billing problems.


• Working with Medicare intermediaries and CMS to clarify billing requirements. Document and track all communications and instructions received from government agencies.


• Responsible to ensure that SMH meets the regulatory requirements for price transparency


• Review all Medicare newsletters, updates, and perform periodic review of the CMS Medicare fiscal intermediary websites and keep informed of pending changes. Review Medicare intermediary third party payer bulletins to keep current on billing requirements. Communicate all pertinent information to applicable departments.


• Works with advisory vendors on CDM audits.


• Develop, implement and monitor the charge-master database system, which enables reporting on financial and operational CDM data point person.


• Will work directly with the Director of Finance on the forecasting of revenues based upon CDM changes.


• Work towards a 3-year plan for a CDM accuracy rate ≥ 99.5%


• Work towards a 3-year plan for increasing the % of total facility and clinic charges processed end-to-end through your automated workflows. > 80%


• Reduction of charge exceptions by 15% within the first year, working toward 5% by year 3


• Build and maintain charge transformation rules


• Timely completion of quarterly charge-master reviews per schedule within 2 weeks of start of quarter


• Will work directly with various data sources in monitoring and evaluation of the charge master. Must be comfortable working with large data sets


• Will chair the monthly revenue integrity committee meeting and report back directly to the CFO on work list and progress.


• Will play a pivotal role in the development and maintenance of charge automation throughout the organization.

POSITION QUALIFICATIONS

Education, Experience & License

• High school diploma or general equivalency diploma (GED), required.


• Bachelor's degree in a health-care-related field, business, finance or accounting or an associate’s degree or Health Care, preferred.


• Professional License (i.e. nursing, radiology, respiratory therapy)


• Three years’ experience in a chargemaster or revenue integrity related role or three years of related experience with one of the following: knowledge of CPT/HCPCS coding and revenue coding, required.


• Preferred: advanced working knowledge of Microsoft Office Programs (Word, Excel, Access, PowerPoint) and other software for researching issues concerning CDM maintenance.


• Coding Certification CPC, CPC-H (AAPC) or CCS (AHIMA), RHIT, RHIA preferred or relevant experience and CEU.

Additional Skills

• Ability to communicate in English, both verbally and in writing.


• Other languages preferred.


• Thorough understanding of Medicare, Medicaid, HMO's, PPO's, private insurance companies.

Specific demands not listed: Possible exposure to blood and or body fluids / infectious disease / hazardous waste requiring the use of Personal Protective Equipment. Exposure to odorous chemicals / specimens and Latex products.

Pre-employment drug and alcohol screening is required.

Sheridan Memorial Hospital is an equal opportunity/Affirmative Action employer and gives consideration for employment to qualified applicants without regard to race, color, religion, age, sex, national origin, disability or protected veteran status. If you would like more information about your EEO rights as an applicant under the law, please click here.