Revenue Integrity Coordinator

Job Summary

Responsibilities

• Maintains and provides information on status of audits and issues presented.
• Works on special projects as required.
• Participates in required regulatory change implementations and ongoing monitoring related to compliant charge capture.
• Monitors various work queues and reports to identify pending charges and works to resolve issues.
• Researches coding errors to identify resolutions.
• Provides feedback to providers to correct errors.
• Recommend sound billing/coding best practices that are able to withstand audits.
• Foster continuous improvement of revenue cycle processes through education with various departments and trend analysis.
• Identifies patterns for educational opportunity, researches coding questions, and tracks audited cases.
• Works within Cerner and within SSI to correct billing issues.
• Works with additional EMRs (Patient Keeper, Paragon) to review billing/coding.
• Performs periodic review of codes and works with patient billing regarding bundling and unbundling services as delineated in CMS and CCI edits.
• Researches technical guidance in CPT/HCPCS Guide, CMS website, Medicare Manuals, etc. to resolve billing issues and promote regulatory compliance.
• Performs work on pre-bill and post-bill claim edits involving any type of clinical or coding review or required modifier based on services rendered.

Qualifications/Requirements

• Experience: Minimum two years clinical experience in a healthcare setting, Preferred experience in Excel and Electronic Medical Records experience.
• Education: High School Diploma required. Associate’s Degree preferred or two years’ work experience.
• Licenses / Certifications: Certified Professional Coder (CPC) or similar credential, preferred.
• Other: Familiarity with medical record documentation standards and practices, health care insurance billing issues, and federal and state billing compliance issues for hospitals; knowledge of CPT-4 codes and ICD-10-CM codes is preferred.

Special Requirements

• Requires travel to other WMCHealth Facilities.