Revenue Integrity Specialist

This is a fully remote position, open to applicants in United States.

📋 Description

• Evaluates charge reviews, claims, and denial adjustments for adherence to CCI, OCE, MUE claim edits, as well as LCD & NCD billing regulations, while optimizing reimbursement.

• Assists in the development, testing, implementation, maintenance, and operational enhancement of Epic’s Revenue Guardian module and associated claim editing software.

• Analyzes billing edit patterns to determine the need for retraining and optimization of editing tools.

• Communicates training and optimization requirements to clinical leadership, the chargemaster committee, compliance, and related departments.

• Accurately and compliantly manages payor and claim CCI, OCE, MUE, LCD, and NCD edits.

• Monitors edited accounts, correspondence, actions, outcomes, coordination, and follow-ups for payor and claim edits.

• Reports on edit and denial appeal trends and activities to Revenue Cycle Leadership.

• Assists various departments in ensuring compliance with government regulations concerning claim edits.

• Collaborates with revenue cycle leadership, the chargemaster committee, and clinical departments to guarantee optimal charge capture.

• Maintains up-to-date knowledge of payer policies and government regulations, relaying pertinent information to leadership.

• Conducts root-cause analyses for high-volume edits and collaborates with Epic technical teams, clinical departments, and HIM to rectify errors and missed charges.

• Reports on claim-edit volumes and identifies new claim errors resulting from updated policies.

• Reviews claims to ensure that documentation substantiates captured charges.

• Supports Revenue Cycle Leadership and prioritizes tasks to decrease edit volume and adhere to payer appeal deadlines.

⛳️ Requirements

• High School Diploma or equivalent.

• Minimum of two (2) years of experience in billing or revenue cycle.

• Proficiency in using computers effectively.

• Familiarity with medical terminology, ICD-10, CPT, and HCPCS codes.

• Strong analytical and critical thinking skills along with clear and concise communication abilities to interact effectively with all management levels.

• Competence in using copiers and fax machines effectively.

• Good analytical skills, including proficiency in Microsoft Excel and reporting tools.

• Excellent communication skills and a professional demeanor are essential.

• Understanding of payor clinical reimbursement policies and government regulations.

• Knowledge of ACP/MPFS payment structures and other third-party payment methods.

• Ability to perform frequent walking, standing, stooping, kneeling, pushing, lifting, grasping, and feeling throughout the work shift.

• Capability to sit for prolonged periods.

• Must possess reading and comprehension skills.

• Preferred: Bachelor’s degree in business or a healthcare-related field or a graduate in Health Information Technology.

🏝️ Benefits

• Competitive salary and comprehensive benefits package.

• Opportunities for professional development and career advancement.

• Supportive work environment with a focus on teamwork and collaboration.