Revenue Integrity Specialist / Revenue Cycle Cmdr Coding

Hartford HealthCare • Farmington, CT

90d

About The Position

The Revenue Integrity Specialist determines the appropriateness of patient charges, and Charge Description Master (CDM) assigned HCPCS/CPT coding, by reviewing the medical record, facility protocol, and other applicable documentation. This review includes the verification of billing data for accuracy and completeness, following regulatory requirements, in order to resolve edits, denials or exceptions detected during system processing of the claim.

Requirements

• High School diploma or GED required.
• Undergraduate degree preferred.
• Healthcare experience required.
• Clinical experience preferred.
• CCS, CCS-P, CP, RHIT, RHIA certification is required.
• Licensed RN preferred.

Nice To Haves

• Excellent communication skills both verbal and written.
• Good interpersonal skills.
• Able to establish good customer relationships with trust and respect.
• Able to travel as needed.
• Computer skills: navigation and edit resolution through various Web based systems. Ability to use email, Excel, Word.

Responsibilities

• Analyze and resolve specific billing edits and denials that require coding and billing expertise with some clinical knowledge that are delaying claims from processing in the Patient Accounting system.
• Verify (and/or correct) billing data for accuracy and completeness, by following regulatory requirements, and reviewing the medical record, facility protocol, and other applicable documentation.
• Apply modifiers, diagnosis codes as appropriate including charge corrections.
• Identify charging, coding, or clinical documentation issues and work with appropriate leadership and ancillary, Patient Financial Services, HIM, departments, etc. regarding charging and clinical documentation issues.
• Participate as a member of the Revenue Integrity work group and report charging and medical necessity issues as appropriate.

Benefits

• Competitive benefits program designed to ensure work/life balance.

What This Job Offers

• Industry: Religious, Grantmaking, Civic, Professional, and Similar Organizations
• Education Level: High school or GED