Revenue Integrity Specialist
Planned Parenthood of Illinois.com
Office
Chicago, IL
Full Time
Just a few of the Benefits enjoyed by PPIL employees…
-Company subsidized premiums on Medical, Dental, and Vision Insurance-Up to 12 weeks Paid Parental Leave for eligible employees-Generous Paid Time Off (PTO) and paid holidays-Mission focused work-401k with employer matching-100% company-paid Life Insurance-100% company-paid Short- and Long-Term Disability Coverage-Robust Employee Assistance Program-Professional Development awards and opportunities-Flexible Spending Accounts-Free Medical Services at PPIL-Pet Insurance
The Revenue Integrity Specialist plays a critical role within the Revenue Cycle team by ensuring accurate and timely charge capture, billing, and reimbursement for clinical services. This position is responsible for analyzing charge data, resolving EPIC suspended edits, and maintaining the non-systems Revenue Cycle Charge Master. Through collaboration with clinical, IT, and financial departments, the Specialist ensures that all services documented in clinical records are properly captured and billed in compliance with state, federal, and payer regulations.
Essential Functions:Charge Master 1. Research billing and coding regulations to ensure organizational compliance 2. Communicate and submit the necessary documentation and technical data that the Business Operations Technology (BOT) team needs to make necessary changes that impact policy, financial, charge capture, billing, and coding operations 3. Perform daily maintenance and quarterly audits of the charge master to ensure up-to-date coding and encounter pricing is maintained for billing accuracy 4. Liaison with Revenue Cycle, IT and clinical departments to ensure updates to the charge master 5. Responsible for the submission and follow-up of new service codes and deactivation of outdated service codes and pricing to ensure state, federal and payer billing compliance 6. Work with purchasing to ensure that the correct annual and quarterly 340B pricing is maintained 7. Maintain current knowledge of Charge Description Master (CDM), Charge Preference List (CPL), and Flowsheet Charging to provide revenue cycle support
Charge Capture and Reconciliation 8. Follow up with Health Center staff to ensure all services are entered into the patient accounting system 9. Work with the Health Centers if system downtime and outages are encountered to ensure that clinical documentation and charges are entered timely for billing 10. Audit charges captured by clinical departments for accuracy and completeness. Ensures that charges are crossing to the bill as intended for RCM Vendor submissions 11. Troubleshoot charge posting issues. Identify charging opportunities. Manage assigned EPIC work queues 12. Responsible for reviewing and resolving all pre-bill suspended charge edits daily to ensure timely system claims data info crossover to the RCM billing vendor for submission to the payer 13. Assist patients with billing questions and concerns 14. Maintain lab vendors portal on missing or updated information needed for laboratory work
Post Visit Revenue Loss Mitigation 15. Audit post-visit charge coding and clinical data to ensure that the appropriate billing service codes are consistently appended prior to submission to the billing vendor to ensure OIG, state, federal and payer compliance 16. Identify charge capture opportunities (missed billing, over-charging, under-charging) or compliance issues in revenue-producing departments and assist with the interdepartmental implementation of process improvements 17. Contribute to organizational improvement initiatives directed by department leaders, focusing on exceeding the RCM KPIs for performance metrics 18. Analyze internal credit balance, automated system, and manual vendor contractual adjustment data methodologies daily to assist with identifying and resolving patient accounting inaccuracies before the month end close 19. Actively participate in team development, achieving dashboards, and in accomplishing departmental goals and objectives 20. Maintain up-to-date and current knowledge of charge capture workflows and proactively maintain and increase knowledge of professional coding and revenue integrity compliance through on-going, self-started professional development
Other Essential Responsibilities: 21. Demonstrate an understanding of and commitment to remain informed about PPIL protocols, policies, and procedures 22. Demonstrate an understanding of and commitment to PPIL core values of access, activism, care, confidentiality, diversity, excellence, integrity, respect, self-determination, and stewardship; practice these values in relations with internal and external customers 23. Other duties and special projects as assigned
Physical Demands: The physical demand characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to stand, walk, talk, read, see and hear. The employee is frequently required to use hands and fingers to type, handle, or feel and reach. The employee is regularly required to sit. The employee must occasionally lift and/or move up to 25 pounds.
Supervisor: Director of Payer Relations and Revenue Cycle ManagementStatus: Full-time. Non-exempt from the overtime provisions of the wage and salary regulations.
Required Education and Qualifications:• High School Diploma or GED • Certification in Coding • Strong knowledge of Commercial, Medicaid/MCO Insurances • Knowledge of CPT, HCPCS, and Revenue Codes • Knowledge of revenue cycle workflow processes and professional medical billing • Familiarity with government and managed care reimbursement methodologies • Ability to research payer requirements and policies • Knowledge of NCCI edits, LCDs/NCDs • 3+ year’s revenue cycle experience including, but not limited to, revenue integrity, billing, coding, denials, and patient account management • Technology skills must include expertise in the use of spreadsheet software and electronic records systems
Preferred Education and Qualifications:
• Associate’s degree or equivalent combination of experience and education preferred. • At least one year of experience working within EPIC as an end user is preferred. • Project management and database management skills desired.
Professional Qualities:
This Specialist is a proactive problem-solver with strong analytic and interpersonal skills that possesses: • Excellent follow-through and attention to detail • Ability to proactively prioritize • Excellent interpersonal relationship management skills • Strong communication, written and oral, and excellent organizational skills • Ability to work under pressure and meet stringent deadlines in a fast-paced environment • Commitment to maintaining confidential information Planned Parenthood works affirmatively to include diversity among its workforce and does not discriminate in the selection of its staff based on factors including but not limited to race, color, religion, sex, national origin, age, sexual orientation, gender identity, disability, income, marital status or any other characteristic protected under federal, state or local law. We know that BIPOC and women identifying candidates are less likely to apply to jobs unless they meet every requirement. Please do not be deterred if your experience doesn’t align perfectly with every qualification in the job posting.
-Company subsidized premiums on Medical, Dental, and Vision Insurance-Up to 12 weeks Paid Parental Leave for eligible employees-Generous Paid Time Off (PTO) and paid holidays-Mission focused work-401k with employer matching-100% company-paid Life Insurance-100% company-paid Short- and Long-Term Disability Coverage-Robust Employee Assistance Program-Professional Development awards and opportunities-Flexible Spending Accounts-Free Medical Services at PPIL-Pet Insurance
The Revenue Integrity Specialist plays a critical role within the Revenue Cycle team by ensuring accurate and timely charge capture, billing, and reimbursement for clinical services. This position is responsible for analyzing charge data, resolving EPIC suspended edits, and maintaining the non-systems Revenue Cycle Charge Master. Through collaboration with clinical, IT, and financial departments, the Specialist ensures that all services documented in clinical records are properly captured and billed in compliance with state, federal, and payer regulations.
Essential Functions:Charge Master 1. Research billing and coding regulations to ensure organizational compliance 2. Communicate and submit the necessary documentation and technical data that the Business Operations Technology (BOT) team needs to make necessary changes that impact policy, financial, charge capture, billing, and coding operations 3. Perform daily maintenance and quarterly audits of the charge master to ensure up-to-date coding and encounter pricing is maintained for billing accuracy 4. Liaison with Revenue Cycle, IT and clinical departments to ensure updates to the charge master 5. Responsible for the submission and follow-up of new service codes and deactivation of outdated service codes and pricing to ensure state, federal and payer billing compliance 6. Work with purchasing to ensure that the correct annual and quarterly 340B pricing is maintained 7. Maintain current knowledge of Charge Description Master (CDM), Charge Preference List (CPL), and Flowsheet Charging to provide revenue cycle support
Charge Capture and Reconciliation 8. Follow up with Health Center staff to ensure all services are entered into the patient accounting system 9. Work with the Health Centers if system downtime and outages are encountered to ensure that clinical documentation and charges are entered timely for billing 10. Audit charges captured by clinical departments for accuracy and completeness. Ensures that charges are crossing to the bill as intended for RCM Vendor submissions 11. Troubleshoot charge posting issues. Identify charging opportunities. Manage assigned EPIC work queues 12. Responsible for reviewing and resolving all pre-bill suspended charge edits daily to ensure timely system claims data info crossover to the RCM billing vendor for submission to the payer 13. Assist patients with billing questions and concerns 14. Maintain lab vendors portal on missing or updated information needed for laboratory work
Post Visit Revenue Loss Mitigation 15. Audit post-visit charge coding and clinical data to ensure that the appropriate billing service codes are consistently appended prior to submission to the billing vendor to ensure OIG, state, federal and payer compliance 16. Identify charge capture opportunities (missed billing, over-charging, under-charging) or compliance issues in revenue-producing departments and assist with the interdepartmental implementation of process improvements 17. Contribute to organizational improvement initiatives directed by department leaders, focusing on exceeding the RCM KPIs for performance metrics 18. Analyze internal credit balance, automated system, and manual vendor contractual adjustment data methodologies daily to assist with identifying and resolving patient accounting inaccuracies before the month end close 19. Actively participate in team development, achieving dashboards, and in accomplishing departmental goals and objectives 20. Maintain up-to-date and current knowledge of charge capture workflows and proactively maintain and increase knowledge of professional coding and revenue integrity compliance through on-going, self-started professional development
Other Essential Responsibilities: 21. Demonstrate an understanding of and commitment to remain informed about PPIL protocols, policies, and procedures 22. Demonstrate an understanding of and commitment to PPIL core values of access, activism, care, confidentiality, diversity, excellence, integrity, respect, self-determination, and stewardship; practice these values in relations with internal and external customers 23. Other duties and special projects as assigned
Physical Demands: The physical demand characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to stand, walk, talk, read, see and hear. The employee is frequently required to use hands and fingers to type, handle, or feel and reach. The employee is regularly required to sit. The employee must occasionally lift and/or move up to 25 pounds.
Supervisor: Director of Payer Relations and Revenue Cycle ManagementStatus: Full-time. Non-exempt from the overtime provisions of the wage and salary regulations.
Required Education and Qualifications:• High School Diploma or GED • Certification in Coding • Strong knowledge of Commercial, Medicaid/MCO Insurances • Knowledge of CPT, HCPCS, and Revenue Codes • Knowledge of revenue cycle workflow processes and professional medical billing • Familiarity with government and managed care reimbursement methodologies • Ability to research payer requirements and policies • Knowledge of NCCI edits, LCDs/NCDs • 3+ year’s revenue cycle experience including, but not limited to, revenue integrity, billing, coding, denials, and patient account management • Technology skills must include expertise in the use of spreadsheet software and electronic records systems
Preferred Education and Qualifications:
• Associate’s degree or equivalent combination of experience and education preferred. • At least one year of experience working within EPIC as an end user is preferred. • Project management and database management skills desired.
Professional Qualities:
This Specialist is a proactive problem-solver with strong analytic and interpersonal skills that possesses: • Excellent follow-through and attention to detail • Ability to proactively prioritize • Excellent interpersonal relationship management skills • Strong communication, written and oral, and excellent organizational skills • Ability to work under pressure and meet stringent deadlines in a fast-paced environment • Commitment to maintaining confidential information Planned Parenthood works affirmatively to include diversity among its workforce and does not discriminate in the selection of its staff based on factors including but not limited to race, color, religion, sex, national origin, age, sexual orientation, gender identity, disability, income, marital status or any other characteristic protected under federal, state or local law. We know that BIPOC and women identifying candidates are less likely to apply to jobs unless they meet every requirement. Please do not be deterred if your experience doesn’t align perfectly with every qualification in the job posting.
Revenue Integrity Specialist
Office
Chicago, IL
Full Time
September 24, 2025