Revenue Integrity Specialist
About The Position
This remote position will help to support billing edit resolution activities for the Laboratory, Pathology and Blood Bank services lines. Candidates with hands-on experience working with claim edits, specifically within Laboratory, Pathology and Blood Bank service lines are preferred. Responsibilities Responsible for charge capture analysis, workflow and maintenance of related work queues in assigned service lines. Works designated work queues to resolve claim edits prior to billing by analyzing medical record documentation and application of payer guidelines. The position will evaluate and provide guidance related to billing and/or clearinghouse system edits. May complete focused charge review assessments for assigned clinical departments and/or service lines to ensure that charges are generated in accordance with established policies and timeframes. Advise service line leaders and their staff on proper usage of charge codes; identify opportunities for capturing additional revenue in accordance with payer guidelines; develop specifications to modify existing charge capture applications to reduce charge-related claim edits/rejections.
Requirements
- H.S. Diploma or General Education Degree (GED) Required
- 3 years of related healthcare experience focused in one or more of the following areas: charge integrity, charge capture/reconciliation, healthcare compliance, charge auditing, CDM management, coding and/or hospital billing procedures Required
- Experience working with Epic
- AHIMA certification (e.g. RHIA, CCS, RHIT) or AAPC Certification (e.g. CPC, CPH, CA) REQUIRED or RN - Registered Nurse - Georgia State Licensure and/or NLC/eNCL Multistate Licensure
- RN licensure or certified healthcare provider (e.g. MT, RT)
Nice To Haves
- Associate’s Degree in HIM/HIT Preferred or Bachelor’s Degree in HIM/HIT Preferred
Responsibilities
- Responsible for charge capture analysis, workflow and maintenance of related work queues in assigned service lines.
- Works designated work queues to resolve claim edits prior to billing by analyzing medical record documentation and application of payer guidelines.
- The position will evaluate and provide guidance related to billing and/or clearinghouse system edits.
- May complete focused charge review assessments for assigned clinical departments and/or service lines to ensure that charges are generated in accordance with established policies and timeframes.
- Advise service line leaders and their staff on proper usage of charge codes; identify opportunities for capturing additional revenue in accordance with payer guidelines; develop specifications to modify existing charge capture applications to reduce charge-related claim edits/rejections.
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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
5,001-10,000 employees
