Revenue Integrity Specialist
About The Position
The Revenue Integrity Specialist reviews charge review, claim, and denial edits to ensure compliance with CCI, OCE, and MUE claim edits and LCD and NCD billing rules while maximizing reimbursement. The position works with Revenue Cycle leadership to support the development, testing, implementation, maintenance, and operational optimization of Epic’s Revenue Guardian module and/or related claim-editing software. It monitors billing-edit trends to identify retraining and editing-tool optimization needs, with the aim of minimizing manual intervention and maximizing compliance. The role also communicates training and optimization needs to clinical leadership, the chargemaster committee, compliance, and related areas through Revenue Cycle leadership. The position requires a high school diploma or equivalent and two years of billing or revenue cycle experience. A bachelor’s degree in business or another healthcare-related field, or graduation from a Health Information Technology program, is preferred. The role is scheduled for 40 hours per week and is non-exempt.
Requirements
- High school diploma or equivalent.
- Two years of billing or revenue cycle experience.
- Ability to use computers effectively.
- Knowledge of medical terminology, ICD-10, CPT, and HCPCS codes.
- Analytical and critical-thinking skills, with clear and concise communication skills for interacting effectively with all levels of management.
- Ability to use a copier and fax effectively.
- Good analytical skills, including use of Microsoft Excel and reporting tools.
- Good communication skills and a professional demeanor.
- Understanding of payer clinical reimbursement policies and government regulations.
- Understanding of ACP/MPFS payment structures and other third-party payment methodologies.
Nice To Haves
- Bachelor’s degree in business or another healthcare-related field, or graduation from a Health Information Technology program.
Responsibilities
- Manage payor and claim CCI, OCE, MUE, LCD, and NCD edits in a timely, accurate, and compliant manner.
- Track edited accounts, correspondence, actions, and outcomes, and coordinate activities and follow-up for payor and claim edits; report trends to Revenue Cycle leadership.
- Monitor, analyze, and report on denials, appeals, and follow-up activities related to billing edits.
- Assist departments with compliance with government regulations as they relate to claim edits, when requested.
- Work with Revenue Cycle leadership, the chargemaster committee, and clinical departments as needed to ensure optimal charge capture for services provided.
- Maintain current knowledge of payer policies and government regulations to support compliant, accurate billing processes, and communicate relevant information to Revenue Cycle leadership.
- Perform root-cause analysis of high-volume edits to reduce non-billable charges; work with the technical Epic team to correct technical errors causing incorrect charge routing and with clinical departments and/or HIM on missed charges.
- Report claim-edit volume to leadership to help reduce edits over time and identify new claim errors resulting from policy updates.
- Review claims to ensure record documentation supports captured charges.
- Provide support and assistance to Revenue Cycle leadership as needed.
- Prioritize work to reduce edit volume effectively and meet payer appeal deadlines.
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What This Job Offers
Job Type
Full-time
Education Level
High school or GED
