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Revenue Integrity Specialist

Description:

RESPONSIBLE FOR:
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.

Qualifications:

MINIMUM EDUCATION REQUIRED:
High School Diploma/GED required.

MINIMUM EXPERIENCE REQUIRED:
Three (3) years of previous 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.

MINIMUM LICENSURE/CERTIFICATION REQUIRED BY LAW:
None.

ADDITIONAL QUALIFICATIONS:
AHIMA certification (e.g. RHIA, CCS, RHIT); AAPC certification (e.g. CPC, CPH, CA), RN licensure and/or certified healthcare provider (e.g. MT, RT) required. Demonstrates understanding of entire revenue cycle with emphasis on charge capture, chargemaster maintenance, coding and billing. Experience working with Epic. Bachelors/Associates Degree in HIM/HIT preferred.