Professional Revenue Integrity Specialist
About The Position
Join Our Team At Oklahoma Heart Hospital (OHH) ONE TEAM. ALL HEART. At OHH, we believe that patient care is truly at the heart of everything we do. Our dedicated team members are involved in every step of our patients' journeys, bringing hope, compassion, and healing to both patients and their families. Together with our physicians and caregivers, we're shaping the future of heart care in Oklahoma by serving the state and leading the nation. Why You'll Love Working Here: Comprehensive 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 Please note that benefits may vary by position, and some roles (like PRN, Flex, Float, etc.) may have exclusions. For eligible positions, benefits start on your first day! We can't wait for you to join our heart-centered team! The Professional Revenue Integrity Specialist is responsible for evaluating charges for professional 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 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. As part of our team, you are empowered to work collaboratively with our physicians and other caregivers, and play an integral role in setting the standard for excellence in patient care. Every team member at OHH plays an integral role in our patients' experience. They are the reason OHH continues to serve the state and lead the nation. Be part of the future of cardiac care.
Requirements
- Education: High school graduate or equivalent preferred.
- Experience: Minimum of two (2) years in Revenue Integrity, coding, charge entry, or billing (professional setting preferred). Knowledge of CPT/HCPCS and ICD-10 coding.
- Working Knowledge: Professional charging and billing, including CPTs and HCPCs, office and facility consultation charges, and E&M leveling is required. Familiarity with medical records and clinical document is preferred.
Nice To Haves
- Cardiology experience is a plus.
- CPC certification is preferred.
- Epic experience is a plus but not required.
Responsibilities
- Review all system and clearing house edits for potentially missing or incorrect charges or modifiers.
- Utilize EMR and clearinghouse to manage claim or charge 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 visit.
- Provide root cause analysis and feedback on incorrect charging practices. Consult and collaborate with adjacent clinics and departments to proactively prevent revenue leakage.
- Assist physicians in placing correct coding 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
Number of Employees
1,001-5,000 employees
