Revenue Integrity Coordinator

FirstHealth of the Carolinas, Inc.•Pinehurst, NC

About The Position

The Revenue Integrity Coordinator supports revenue cycle operations by managing aspects of the Candidate for Billing (CFB) workflow, reviewing billing and reimbursement updates, helping resolve billing and coding issues, and communicating information and trends to staff and leadership. The role works with RCM managers, analysts, leadership, and other departments to improve operations, productivity, charge capture, and billing processes. The coordinator prepares reports, monitors assigned work queues, analyzes issues and their fiscal impact, maintains billing policies and procedures, and helps implement corrective actions to reduce claim rejections and denials. The position also assists with employee education and training and serves as a liaison across departments on billing and charging matters.

Requirements

High school graduation plus two years of additional education in healthcare billing, accounting, or business administration; equivalent work experience may be considered in lieu of post-secondary education.
Strong interpersonal and verbal communication skills.
Ability to manage multiple tasks in an organized manner.
Excellent analytical and critical-thinking skills.
Computer literacy.
Knowledge of CPT-4, HCPCS, UB, and ICD-10 coding.
Knowledge of CMS guidelines and requirements.
Ability to work independently and exercise sound judgment, discretion, and initiative.
Ability to speak and hear effectively for communication.
Mobility or working with hand and arm dexterity.

Nice To Haves

Minimum three years of relevant healthcare experience is preferred.
CPC certification is preferred.

Responsibilities

Manage aspects of the Candidate for Billing workflow, including pre-bill buckets, created buckets older than seven days, DNBS, STOP BILLS, and claim edits.
Review CMS, FI, and carrier websites for bulletins, transmittals, program memorandums, local medical review policies, and other information affecting billing and reimbursement.
Educate staff and distribute relevant billing and reimbursement information.
Work with RCM managers to improve operational flow and assist management with productivity improvements and special situations affecting RCM operations.
Serve as a resource for reporting CDM problems and assist with researching coding issues.
Assist other departments with billing problems.
Assist with in-service training and continuing education for employees.
Use computer systems, printers, copiers, and telephones appropriately.
Comply with departmental and organizational safety and infection-control measures.
Serve as a liaison between departments on billing and charging issues; help identify problem sources and work with the CDM Coordinator, RCM Analysts, and RCM leadership on corrective actions involving the chargemaster and charge-capture processes.
Prepare routine and special reports and inform RCM Analysts and leadership about trends that may affect cash flow.
Keep billing policies and procedures updated.
Monitor assigned work queues and work with departments to resolve issues; analyze trends and their fiscal impact on the organization.
Communicate with personnel throughout the revenue cycle and provide process-improvement recommendations.
Keep administration informed of activities and concerns through timely verbal and written communication.