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Revenue Cycle Integrity Analyst
2 months ago
Position Overview:
ONE TEAM. ALL HEART. At Oklahoma Heart Hospital, our commitment to patient care drives every aspect of our operations. This physician-owned facility is meticulously designed by cardiologists to ensure that patients receive specialized, individualized treatment in a comfortable environment. We provide a comprehensive benefits package to all employees from the outset of their employment.
Comprehensive Benefits Include:
- Medical, Dental, and Vision Coverage
- 401(k) Retirement Plan
- Paid Time Off (PTO)
- Extended Medical Benefits
Position Type: Full-Time, Days
Key Responsibilities:
The Hospital Revenue Integrity Specialist plays a crucial role in assessing hospital claims charges 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. Responsibilities also include managing pre-bill edits associated with clinical documentation, such as CCI edits, MUEs, and billing edits. The role facilitates a charge reconciliation program in collaboration with clinical leadership, ensuring effective communication regarding any discrepancies in charges and providing recommendations for best practices.
- 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 in accordance with payer regulations, ensuring clean claims are submitted within five days post-discharge.
- Conduct root cause analysis and provide feedback on inaccurate charging practices, collaborating with adjacent departments to proactively mitigate revenue loss.
- Assist healthcare providers in accurately coding procedures during service orders or renderings.
- Propose 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 within a hospital environment is preferred. Familiarity with CPT/HCPCS and ICD-10 coding is essential. Experience in cardiology is advantageous. AHIMA or AAPC certification is preferred.
