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Overview

Full Time Remote Position. This position's main responsibility is to process clinical claim edits within the Epic system to ensure our initial claim to the payer is as clean as possible to ultimately prevent an initial denial. Knowledge about revenue codes, modifiers, hcpcs codes, cpt codes, diagnosis codes, and charges is a huge plus. A vast knowledge of the Epic system is also a plus. Clinical licensure or any type of coding certifications are also a plus in this role.

Summary

Revenue integrity professionals will create value for our clinical areas, principally in revenue recovery and claim acceleration. This role requires extensive knowledge of Medicare Integrated Outpatient Code Editor (I/OCE) associated with Healthcare Common Procedure Coding System (HCPCS), Ambulatory Payment Classification (APC), HCPCS Modifier, and quarterly Revenue Code additions, changes, and deletions.

Accountable for assigned and delegated reports and completion from senior leadership and/or department director. Assist the Revenue Integrity Coordinator to ensure consistency in delivering services efficiently, timely, and great quality to all hospitals and BMH entities. Assist the Revenue Integrity Coordinator to ensure the integrity of the processes and that federal and state compliance is met in regards to charging and billing practices for healthcare services. Strives to reach and maintain department goals at the highest standard in all areas of responsibility, task, and patient satisfaction as set by Administration and Corporate expectation. Takes initiatives to improve processes, strives for positive customer outcomes. Leads by example.

Responsible for all shifts, 7 days/week, 24 hours/day.

Responsibilities

+ Has joint ownership of assigned account and claim edit work queues, clinical departments and continually coordinates between administrative and clinical operations staff to ensure accounts have the correct coding, billing, payment and charge captures.

+ Serves a resource and liaison for clinical charging and financial areas as related to appropriate coding and charge capture compliance based upon regulatory, coding, and billing guidelines by payer.

+ Review patient medical records for charge capture and resolution of charge department billing edits in conjunction with reviewing clinical documentation to validate missing charges.

+ Demonstrates Service First characteristics to all. Sets example for department and other hospital personnel. Identifies opportunities for improvement resulting in enhanced service and customer satisfaction.

+ Performs related accountabilities/responsibilities as required or directed without complaint.

Requirements, Preferences and Experience

Experience

Description

Minimum Required

Preferred/Desired

A minimum of 3 years in the healthcare industry with a working knowledge of hospital and/or physician revenue cycle functions.

A minimum of 6 years in the healthcare industry with a working knowledge of hospital and/or physician revenue cycle functions.

Education

Description

Minimum Required

Preferred/Desired

Associate Degree or equivalent combination of experience and education.

Bachelor’s degree in Health Information Management or Nursing.

Training

Description

Minimum Required

Preferred/Desired

Working knowledge of current medicare, medicaid, and other regulatory IPPS/OPPS guidelines and requirements; nThrive Knowledge Source application; Working knowledge of Microsoft Office products. Attention to Excel application; Knowledge of the different types of clinical settings; Knowledge of facility and professional billing claim forms, fields, and values; Knowledge of facility and professional billing requirements; Knowledge of medical coding rules and regulations.

REQNUMBER: 33522