Revenue Integrity Specialist

Overview

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.

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.

Qualifications

Education

• H.S. Diploma or General Education Degree (GED) Required
• Associate’s Degree in HIM/HIT Preferred or
• Bachelor’s Degree in HIM/HIT Preferred

Work Experience

• 3 years of related healthcare experience focused in one or more of the following areas: charge integrity Required
• charge capture/reconciliation Required
• healthcare compliance Required
• charge auditing Required
• CDM management Required
• coding and/or hospital billing procedures Required
• Experience working with Epic Required

Licenses and Certifications

• AHIMA certification (e.g. RHIA, CCS, RHIT) Upon Hire Required or
• RN - Registered Nurse - Georgia State Licensure and/or NLC/eNCL Multistate Licensure RN licensure Upon Hire Required or
• certified healthcare provider (e.g. MT, RT) Upon Hire Required
• AAPC certification (e.g. CPC, CPH, CA)

Business Unit : Company Name

Piedmont Healthcare Corporate