Revenue Integrity Specialist

Piedmont Healthcare Inc.•Vinings, GA

3d•Onsite

About The Position

At Piedmont Healthcare, you’ll love a shared purpose, be motivated to be your best, and be recognized for your contributions. Piedmont Healthcare leaders are in your corner and invested in your success. Our wellness programs and comprehensive total benefits and rewards will meet your needs for today and help you plan for the future. The Revenue Integrity Specialist is responsible for charge capture analysis, workflow and maintenance of related work queues in assigned service lines. This position works designated work queues to resolve claim edits prior to billing by analyzing medical record documentation and application of payer guidelines. The role will evaluate and provide guidance related to billing and/or clearinghouse system edits. It may also 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. The specialist will advise service line leaders and their staff on proper usage of charge codes; identify opportunities for capturing additional revenue in accordance with payer guidelines; and develop specifications to modify existing charge capture applications to reduce charge-related claim edits/rejections.

Requirements

H.S. Diploma or General Education Degree (GED)
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
Experience working with Epic
AHIMA certification (e.g. RHIA, CCS, RHIT) Upon Hire
RN - Registered Nurse - Georgia State Licensure and/or NLC/eNCL Multistate Licensure RN licensure Upon Hire
certified healthcare provider (e.g. MT, RT) Upon Hire

Nice To Haves

Associate’s Degree in HIM/HIT
Bachelor’s Degree in HIM/HIT

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.
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.