Revenue Integrity Coordinator 2

The Ohio State University

1d • Remote

About The Position

The Revenue Integrity Coordinator supports hospital claims processing and functions in the coding department. Responsible for maintaining current knowledge of the various regulatory agency guidelines and assure requirements are met along with accurate, complete, and timely charge processes. Responsible for reviewing, analyzing, and resolving hospital claim edits that prevent claims from being billed or paid. This position supports accurate and timely revenue capture by identifying and correcting claim errors related to coding, medical necessity, and payer-specific requirements. The specialist works to ensure claim edits are resolved within established timelines and compliance standards.

The Revenue Integrity Coordinator reviews hospital claims to compliantly apply and resolve claim edits specific to non-Medical Information Management CPT/HCPCS coded charges. Provide feedback and education to departments/cost centers on any opportunities for improvement with charge code selection. Familiarity with medical claims processing and pre-bill edit experience for hospital accounts services which includes: modifiers, CPT, ICD10 and HCPCS; LCDs/NCDs for medical necessity; rejected claims after claim submission, recoding of charges and resubmission of encounters that have failed claim edit logic. May serve as informal resource for less experienced colleagues.

Requirements

• High School diploma or GED.
• 0 years of relevant experience required.
• Familiarity with medical claims processing and pre-bill edit experience for hospital accounts services which includes: modifiers, CPT, ICD10 and HCPCS; LCDs/NCDs for medical necessity; rejected claims after claim submission

Nice To Haves

• 0-2 years of relevant experience preferred.

Responsibilities

• Maintaining current knowledge of the various regulatory agency guidelines and assure requirements are met along with accurate, complete, and timely charge processes.
• Reviewing, analyzing, and resolving hospital claim edits that prevent claims from being billed or paid.
• Identifying and correcting claim errors related to coding, medical necessity, and payer-specific requirements.
• Ensuring claim edits are resolved within established timelines and compliance standards.
• Reviewing hospital claims to compliantly apply and resolve claim edits specific to non-Medical Information Management CPT/HCPCS coded charges.
• Providing feedback and education to departments/cost centers on any opportunities for improvement with charge code selection.
• Recoding of charges and resubmission of encounters that have failed claim edit logic.
• May serve as informal resource for less experienced colleagues.

Benefits

• Eligible Ohio State employees receive comprehensive benefits packages, including medical, dental and vision insurance, tuition assistance for employees and their dependents, and state or alternative retirement options with competitive employer contributions.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED