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Revenue Integrity Analyst

2 months ago

Oklahoma City, Oklahoma, United States Oklahoma Heart Hospital Full time

Position Overview:

ONE TEAM. ALL HEART. At Oklahoma Heart Hospital, we prioritize patient care above all else. Our facility, established by cardiologists, is dedicated to providing exceptional, personalized care in a comfortable environment. We offer a comprehensive benefits package to all employees from the outset of their employment.

Benefits Include:

  • Medical, Dental, and Vision coverage
  • 401(k) retirement plan
  • Paid Time Off (PTO)
  • Extended Medical Benefits (EMB)

Position Summary:

The Hospital Revenue Integrity Specialist plays a crucial role in assessing charges for hospital claims against clinical documentation to pinpoint any missing, erroneous, or delayed charges. This position involves evaluating charge capture processes to ensure compliance with both governmental and non-governmental regulations. The specialist will manage pre-bill edits associated with clinical documentation, including CCI edits, MUEs, and billing adjustments. Additionally, the role includes facilitating a charge reconciliation program in collaboration with clinical leadership, providing updates on any discrepancies, and recommending best practices.

Key Responsibilities:

  • Examine all system and clearinghouse edits for potentially missing or incorrect charges or modifiers.
  • Leverage EMR and clearinghouse tools to manage claim edits, safeguarding revenue and ensuring accurate charge entry based on clinical documentation.
  • Validate claims data against payer guidelines, ensuring clean claims are submitted within five days post-discharge.
  • Conduct root cause analysis and provide feedback on improper charging practices, collaborating with related departments to proactively mitigate revenue loss.
  • Assist healthcare providers in accurately coding procedures when ordering or delivering services.
  • Advise on system enhancements to capture frequently overlooked or incorrect charges.

Qualifications:

Education: High school diploma or equivalent preferred.

Experience: A minimum of two years in Revenue Integrity, coding, charge entry, or billing, preferably in a hospital environment. Familiarity with CPT/HCPCS and ICD-10 coding is essential. Experience in cardiology is advantageous. Certification from AHIMA or AAPC is preferred.