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Hospital Revenue Integrity Specialist
3 months ago
Top Tier Benefit Packages:
Medical, Dental, and Vision 401 (k) plan Paid Time Off (PTO)
Extended Medical Benefit (EMB) Location:
Business Office- 7800 NW 85th Terrace, OKC OK 73135 Shift: Full-Time, Days.
Responsibilities
The Hospital Revenue Integrity Specialist is responsible for evaluating charges for hospital claims against clinical documentation to identify missing, incorrect, or late charges.
Evaluates charge capture processes to comply with government and non-government rules and regulations. Works pre-bill edits related to clinical documentation, to include CCI edits, MUEs, and billing edits.Facilitates a charge reconciliation program with clinical leadership and provides communication on missing or incorrect charges, and makes recommendations on best practice.
Review all system and clearing house edits for potentially missing or incorrect charges or modifiers.Utilize EMR and clearinghouse to manage claim edits to preserve revenue and ensure all charges are added correctly based on clinical documentation.
Validate claims data against payer rules and regulations, and provide clean claims within five days from discharge. Provide root cause analysis and feedback on incorrect charging practices. Consult and collaborate with adjacent departments to proactively prevent revenue leakage. Assist physicians in placing the correct procedure code for procedures when ordering or rendering services. Recommend system optimization to capture frequently missed or incorrect charges.Qualifications
Education:
High school graduate or equivalent preferred
Experience:
Minimum of two (2) years in Revenue Integrity, coding, charge entry, or billing (hospital setting preferred). Knowledge of CPT/HCPCS and ICD-10 coding. Cardiology experience is a plus. AHIMA or AAPC certification is preferred.
The Hospital Revenue Integrity Specialist is responsible for evaluating charges for hospital claims against clinical documentation to identify missing, incorrect, or late charges.
Evaluates charge capture processes to comply with government and non-government rules and regulations. Works pre-bill edits related to clinical documentation, to include CCI edits, MUEs, and billing edits.Facilitates a charge reconciliation program with clinical leadership and provides communication on missing or incorrect charges, and makes recommendations on best practice.
Review all system and clearing house edits for potentially missing or incorrect charges or modifiers.Utilize EMR and clearinghouse to manage claim edits to preserve revenue and ensure all charges are added correctly based on clinical documentation.
Validate claims data against payer rules and regulations, and provide clean claims within five days from discharge. Provide root cause analysis and feedback on incorrect charging practices. Consult and collaborate with adjacent departments to proactively prevent revenue leakage. Assist physicians in placing the correct procedure code for procedures when ordering or rendering services. Recommend system optimization to capture frequently missed or incorrect charges.Education:
High school graduate or equivalent preferred
Experience:
Minimum of two (2) years in Revenue Integrity, coding, charge entry, or billing (hospital setting preferred). Knowledge of CPT/HCPCS and ICD-10 coding. Cardiology experience is a plus. AHIMA or AAPC certification is preferred.
