Revenue Integrity Specialist

About the role

Responsible for charge capture analysis, workflow, and maintenance of related work queues in assigned service lines. Evaluates and provides 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 charges are generated in accordance with established policies and timeframes.

Responsibilities

• Work designated work queues to resolve claim edits prior to billing by analyzing medical record documentation and applying payer guidelines.
• 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.

Requirements

• High School Diploma or General Education Degree (GED) required.
• Associate’s or Bachelor’s Degree in HIM/HIT preferred.
• 3 years of 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.
• Experience working with Epic required.

Qualifications

• AHIMA certification (e.g., RHIA, CCS, RHIT) required upon hire, or
• RN – Registered Nurse – Georgia State Licensure and/or NLC/eNCL Multistate Licensure required upon hire, or
• Certified healthcare provider (e.g., MT, RT) required upon hire.

Business Unit: Piedmont Healthcare Corporate