Hospital Revenue Integrity Specialist
Oklahoma Heart Hospital•Oklahoma City, OK
•Onsite
About The Position
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.
Requirements
- High school graduate or equivalent preferred.
- Minimum of two (2) years in Revenue Integrity, coding, charge entry, or billing (hospital setting preferred).
- Knowledge of CPT/HCPCS and ICD-10 coding.
Nice To Haves
- Cardiology experience is a plus.
- AHIMA or AAPC certification is preferred.
Responsibilities
- 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.
Benefits
- Medical, Dental, and Vision coverage
- 401(k) plan with employer match
- Long-term and short-term disability
- Employee Assistance Programs (EAP)
- Paid Time Off (PTO)
- Extended Medical Benefits (EMB)
- Opportunities for continuing education and professional growth
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
